710227.pdfC..
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
NAMES
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NEW
RESIDENTIAL
LINE
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NON-RESIDENTIAL
BION
ADD
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WALLRETAININE
DEMOLISH
EXAVAT❑ E
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ORCFILL
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REPAIR
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PRE -MOVE
INSP.
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POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
C.
DLL MAP No.: PERMIT
NUMBER
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EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT -
❑ YES ❑ NO
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
1
SIGN
RETAINING WALL
IBWIMMIN6
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating ccnstruction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In sixmonths.)
BIGNAT E AGE DATE 6V;Y
INSPECTION
_DEPARTMENT
OITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR a-llo7
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.
710227
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
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BY
❑ YES ❑ NO
Fee
No.
rr1Z 140101
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
�_ 11 S_�"l
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