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ENT Applicant Fm
' Inside Heavy Linos a0�
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NEW
ADD
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' ��REPAIR
NUMHEROF. B'
. /+ �- � NATURE OF W
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REBH)ENTLtL
6A8
LUVH
NON-RESIDENTIAL
� BION
,DEMOLISH
RETAINING
� WALL
aEXCAVATE
FENCE
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OR FILL
(„_...at_........FtJ
PRE -MOVE ..
ffi8P.
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8W1M
POOL
IEB
N[IMBER OF
DWELLING
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I herobq acknowledge that I Gave reed thL appllcaUon; that the !n-
formation given fe correct; m6 that I am the oaver, or the duly author-
. lred agent of tha owner. I agree to comply with city and state laws regu-
]atlag constructfoa; sad In doWg the work autttorized thereby, ao person
will be employed In violation of the Labor Code o[ the state of Washington
rolatln6 to Workmen's Compeneatloa Imurrwce.
NOTE: P�arlllif Umit One Year <Egcept DE\fOLITIO?f8 whleh
sfali bo comJleled !n ninety days; MOVED -IN RVILDINOB shall be wm-
pleted In abt months.)
816N (OWNER AOENT) DArTE BIONED
I V �� � ��
NOTE: Applicant Subj o Plau Cbcck Fec
Tlrls Permit rnven work to be done on prlvata property ONLY.
Any eonstnnctlon on the pablle domain (earbe, stde�valke, drhrowsYs,
marquee, etc.) wilt rogmro separate permission.
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PEAMrr
NVMHER
EXISTING STREET R/W ..._.......F'r. DEBTOIENOY THIS PROPERTY �.I � I �� �: � .. �. . � I _.
❑ YE8 ❑ NO
PLUMSIN6
HEAT d: OA8 LINE
FENCE
BION
RETAINING WALL
OWIMMIN6 POOL
DEMOLITION
PAE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL A11fOUNT DUE
TRIB PERDDT
AL'TIiORIZEB
ONLY TFZL�.
WORN NOTED
INSPECTION
DEPARTMENT
CITY OF
EDi♦SONDS
PR &I30T
� YE8
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APPLICATION APPROVAL � �
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-..This applicationds mot'a permit -until JJ
signed by the Building Official or his Dep-' 1
uty; and fees are paid, and receipt is ac � 1,
]tnowledged in space provided. � � ,
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DATE � t
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