710135.pdfAf
BUILDING DEPARTMENT I Applicant FM
PERMIT APPLICATION Inside Heavy Lines
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CITY
TELEPHONE NUMBER
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LICENSE NUMBER
CITY
LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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RESIDENTIAL
GAS
LINE
-
NEW
NON-RESIDENTIAL
❑
SIGN
ADD
❑ DEMOLISH
W AID. KING
EXCAVATE
FENCE
-
ALTER
OR FILL
(.........•xFt.)
REPAIR
PRE -MOVE
❑ INSP.
.........
swim
POOL
B
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DWELLING
UNITS
I hereby acknowledge that 1 have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no Person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PerVimit One Year (Except DEMOLITIONS which
ll a comp ninety days; MOVED -IN BUILDINGS shall be com-
plete ina m
✓ 21
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
ZONE I TYPE OF
❑ YES NO
Plan Check No....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER
710135
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13 YES 13 NO
DEFICIENCY THIS PROPERTY
YES ❑ NO
❑el
No.
TOTAL AMOUNT DUE 1 I / .
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ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his Dep-
ONLY
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DEPARTMENT DIkt OR'S @I(INATU E
OITY OF
EDMONDS DA
PR 6-II07 —
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