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':PERMIT APPLICATION Inside Heavy Lines;e
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IY I RESIDENTIAL OAS
� LINE
NON-RESIDENTIAL ❑ SIGN
❑RETAINING
DEMOLISH WALL
EXCAVATE FENCE
OR FILL ........ 3.......... Ft.)
PRE -MOVE SWIM
INSP. D POOL
DWELLING
UNITS
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EXISTING STREET R/W ...»»»...F T.
COMP, PLAN ST, R/W ............FT.
❑ YES
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ZY1 z 3; 'Plan Check No....................
,. BUILDING
PLUMBING
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tting streets) HEAT do GAB LINE
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C FENCE
\1 SIGN
It RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I , JO'l1 'Y1 A
1 hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duty author.
Ized agent of the owner, I agree to comply with city and dale 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 One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVE0.IN BUILDINGS shall be com.
pleted In six months.)
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PERMIT
NUMBER
J
DEFICIENCY THIS PROPERTY
I HIS SITE IS LOCATED IN T
CITY OF EDMONDS. LQCA E
TAX SHOULD BE CODED 31.0
Valuation Fee
No.
TOTAL AMOUNT DUE I '/ / r (J V I/ 3 O
(p 1
ATTENTION APPLICATION APPROVAL
THUS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TILE
WORN NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided,
4ATURE (O ER O EN DATE SIGNED INSPECTION
DEPARTMENT
' —�/ CITY OF
EDMONDS
NOTE: Applicant Su ect to flan Check Fee
rn a11oq
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.
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