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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME ( )
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Applicant Fill
Inside Heavy Lines
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NEW
RESIDENTIAL
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
RETAI❑
DEMOLISH
a
WALL
ALTER EXAVAT❑ ORC
CFILL E
FENC.XFt.)
..........
❑ REPAIkt ❑ PRE-MOVEEjwim
INSP.
POOL
NUMBER OF BTORiEB NUMBER OF
DWELLING
UNITS
NAT El F WORK TQ BE DONE
-Y �
N —/,
IGLL MAP N I PERMIT 710252
YES i] NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
YES ❑ NO
Pion Check No .....................
BUILDING
PLUMBING
IiEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
N
I SWIMMING 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 elate taws regu- ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
O';ZY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In at sly days; )f ED-IN BUILDINGS shall be com-
pleted elx months.
BIGN tE ( N 'R AGEN I DATE B 6NED INSPECTION
DEPARTMENT
L CITY OF
EDhIONDS
OT Applicant Subject to Plat Check Fee PR OND
6-1107
This Permit covers work to be done on privets property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permleslon.
YES I] NO
THIS SITE IS LOCATED IN THE
CITY OF EDMONDS. LOCAL RAI F
TAX SHOULD BE CODED 31.04.
Fee
25-1s-o
APPLICATION APPROVAL
No.
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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