750274.pdfDE51OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL.
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lhereby acknowledge that I have read this application;
AMOUNT DUE aDPllc¢tlon; that the In. / L
formation given le 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 APPLICATION APPROVAL
lating coaetraetlon; and In doing the work authorized thereby, no Dersan
will be employed In violation of the Labor Code of the Stale of Washington THIS PERMIT This application Is not a perinit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS whirl, WORK
TIIE ut and fees are aid, and receipt Is ac-
ehn coin led In nicety days; MOVED -IN BUILDINGS shall be win. {VOftll NOTED yI P P
led In elg nthe.) llRowledged In apace provided.
IGNATU3 NNE A H T) DATE SIGNED INSPECTION R•8 810NATURE
DEPARTMENT
f'LC>,. , v / • � ' 7�5 CITY OF f '
EDMONDS
NOTE: Applic r Srfhject to Plan Check Fee }
775-2525
This Permit rovers work to be done on private property ONLY.
Any eon el ruction an the public domain (rurbe, sI 1",.lkn, drlvoways, FILE.
r��o,r,, rir.l „Ill rra�urr nrlmratr peri,d.slan.
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BUILDING DEPARTMENTAppllPaDtFlll
SE NU�>T 750274
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PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
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PERMISSIBLE 7 ? ACTUAL
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PERMISSIBLE HEIGHT ( PROPOSED RETORT /1
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TELEPHONE NUMBER
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REQUIRED YARDS PROPOSED—
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Legal Description of Properly (Show Below or Attach Four Copies)
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-� YE9 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
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PLAN CHECKED Y THIS SITE IS LOCATED IN THE CITY
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❑ SIGN
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valuation
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BUILDING
PROPOSED USE
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abutting streets)
HEAT & GAS LINE
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tRETAINING
SIGN
WALL
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SWIMMING POOL
DE51OLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL.
/ �j •)
lhereby acknowledge that I have read this application;
AMOUNT DUE aDPllc¢tlon; that the In. / L
formation given le 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 APPLICATION APPROVAL
lating coaetraetlon; and In doing the work authorized thereby, no Dersan
will be employed In violation of the Labor Code of the Stale of Washington THIS PERMIT This application Is not a perinit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS whirl, WORK
TIIE ut and fees are aid, and receipt Is ac-
ehn coin led In nicety days; MOVED -IN BUILDINGS shall be win. {VOftll NOTED yI P P
led In elg nthe.) llRowledged In apace provided.
IGNATU3 NNE A H T) DATE SIGNED INSPECTION R•8 810NATURE
DEPARTMENT
f'LC>,. , v / • � ' 7�5 CITY OF f '
EDMONDS
NOTE: Applic r Srfhject to Plan Check Fee }
775-2525
This Permit rovers work to be done on private property ONLY.
Any eon el ruction an the public domain (rurbe, sI 1",.lkn, drlvoways, FILE.
r��o,r,, rir.l „Ill rra�urr nrlmratr peri,d.slan.
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