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POSTED ON KROLL MAP NO.:
BUILDING DEPARTMENT Applicant
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS � 0
RESIDENTIAL
❑
GAS
LINE
NEW
NON-RESIDENTIAL
❑
SIGN
ADD
RETAININGA
❑
El
DEMOLISH
ALTER
EXAVAT❑ E
El
OROFILL
(ENC x_........ Ft.)
REPAIR
IN P.
R
SWIM
POOL
DWELLING
UNITS
t
N
I
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
i7 YES i] NO
Plan Check No............
BUILDING
PLUMBING
HEAT & GAS LINE o�
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
*�-W .
STREET IMPROVED
YES ❑ NO
Fee
1
00
I
i
e
o.
TOTAL AMOUNT DUE
I I O J C'L'T� y.
�
;.
.d
I hereby acknowledge that I have read this aDDllcatta¢; that the in-
given is correct; and that I am the Owner, or the duly author-
,,: �
'
agent of the owner. I agree to comply with city and state laws regu. ATTENTION
APPLICATION APPROVAL
g construction; and In doing the work authorized thereby, no person
j
be employed In violation of the Labor Code of the State of Washington THIS PERMIT
This application is not a permit until
ing to Workmen's Compensation Insurance. AUTHORIZES
signed by the Building Official or his Dep-
E: Permit 'mit One Your (Except DEMOLITIONS which WORK NONLY OTED
[sha-
uty; and fees are paid, and receipt is ac-
aation
l a complete n sty days; MOVED -IN BUILDINGS shall be com-
lQlowledged in space provided.,^,,,,-,i
d la six m theATURE
W R OR AGENT) DATE 81Q6NED INSPECTION
D OR'8 GNATU
�>/ DEPARTMENT
, ��L
CITY OFLt�
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
%6
PR a-1107
Thin Permit covers work to be done on private property ONLY.
-
f
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.
-
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