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BUILDING DEPARTMENT ApplicantFlli
PERMIT APPLICATION inside Heavy Lines
F
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-e20o1:,,-
NEW
ElADD
ElALTER
ElREPAIR
s.w .
GAS
RESIDENTIAL LINE
NON-RESIDENTIAL ❑ SIGN
DEMOLISH ❑ RETAINING
L
EXCAVATE FENCE
OR FILL (.......... x.......... Ft.)
PRE -MOVE �—'j SWIM
I l INSP. - I ` POOL
_end
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EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
O YES
NO
OF
DWELLING ' - s
UNITS
r.� -/ U C
Plan Check No .....................
'rj
BUILDING
c�
PROPOSED USE
PLUMBING
PLOT PLAN (Indlcnto Building setbacks, abutting streets)
HEAT k GAS LINE
a
j
FENCE
SIGN
RETAINING WALL
ISWIMMING
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 construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code 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; biOVED-IN BUILDINGS shall be com-
pleted In six months.)
III TUBE (O{YNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
/
I 7
CITY OF
EDAIONDS
NOTE: Appli ant Subject to Plan Check Pee
PR 6-I107
This Permit covers work to be dons on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ra rquees, etc.) will require separate permission.
PERMIT
NUMBER
YES i] NO
DEFICIENCY THIS PROPERTY
I
m
❑ YES ❑ NO
THIS SITE IS LOCATED IN TH
TAX SHOULD BE CODED 31
Valuation I Fee Receipt No.
0
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.
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