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Driveway slopes not to exceed those
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formation given Is correct; and that I am the owner, or the duty author-
STr(/ATEE LICENBE NUMBR4 CITY LICENSE NUMBER
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Ixed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
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REBTARKS
will be employed In violation of the Labor Code of the Slate of Washington
TINS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
Legal Dcscrlplloa al Property (Show Bell, or Attach Four COPlee)
Blk ,cl/TYPE
ONLY THE
WORK NOTED
utyi and fees are paid, and receipt is ac-
shallbe completed In ninety days; MOVED -IN BUILDINGS shall be cam-
CONNECTION ION
I VEAIFIEDwAY
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NUMBER Ol'' BTORI EB NUh(BER OF
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NATURE OF WORK TO BE DONE
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Fee Receipt No.
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PROPOSED USE
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DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE7`
I hereby acknowledge that I have read this application; that the In.
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formation
formation given Is correct; and that I am the owner, or the duty author-
Ixed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
TINS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
utyi and fees are paid, and receipt is ac-
shallbe completed In ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged In space provided.
pleled In six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
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IF
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DEPARTMENT
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CITY OF
EDMONDS
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NOTE: Applicant Subject to Plan Check Fee
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775-2525
This Permit ca work to be done an private property ONLY.
Any const nlribn`on the public domain (curbs, eldrwalke, drl—ye'
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