710159.pdfI
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BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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17N,
XI NEW
7' ADD
ALTER
REPAIR
or
M *IF
u RESIDENTIAL OSE LIAN
NON-RESIDENTIAL ❑ SIGN
RETAINING
11 DEMOLISH F1 WALL
EXCAVATE FENCE
OR FILL I ........ z.„.._...Ft.)
PRE -MOVE SWIM
INSP. POOL
CZKE.—
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
Ised 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: Permit Limit O�n Year (Except DEMOLITIONS which
shall be completed o ninety J�)4; MOVED -IN BUILDINGS shall be com-
NOTE: Applicant Subject to Plan Check Fee
This Permit Coven
work to
be done
on private property ONLY.
Any construction on
the pubuo
domain
(curbs,
eldewalks, driveways,
marquees,
etc.) will
require
separate
permiselea,
C�
EXISTING STREET R/W ...........FT.
COMP. PLAN ST, R/W ............FT.
F1400:11
Plan Check No, .................
BUILDING
HEAT h GAS LIN X�
FENCE
SIGN
RETAINING WALL
I. 9: ..• 1�5 •U
EXCAVATION OR
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORE: NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH e-1107
710159
p YES p NO
DEFICIENCY THIS PROPERTY
MUM
Wk
Valuation Fee Receipt
APPLICATION APPROVAL v
This application is not a permit until
signed by the Building Official or his Dep-
ut • and fees are paid, and receipt t 18 ac-
knowledged i
,
in space provided,
FILE