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PERMIT APPLICATION Inside Heavy Lines JOB
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UNDERGROUND
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uty; and fees are paid, and receipt is ac-
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INSPMOVE
ElPOOL
DATE /
775-2525
s
This Permit covers work to be done on private property ONLY.
REMARKS
Any co nstructlOn on the public domain (curbs, sidewalks, driveways,
NUMBER OF STORIESNUMBER
ORIGINAL - Filr YELLOW - lutipr�ua
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I hereby acknowledge that I have reed this application; the In-
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formation given le correct; and that I am the o uer, ortooth -
Med agent of the owner. I agree to comply with city and. regu-
lating construction; and In doing the work authorized tperson
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the Stahington
THIS PERMIT
relati.9 to Workmen's Compensation Insurance.AUTHORIZES
This application is not a permit until
by the Sullding Official or his Dep -
NOTE: Permit Limit One Year (Except DEMwhich
ONLY THEsigned
uty; and fees are paid, and receipt is ac-
.hall be completed In nicety day.; asOVED-IN BUILDINbe teas-
pleted In elz he.)
WORK NOTED
llnowledged in space provided.
I.BNTUR W E O AGENT)
SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'S NAT RE
1
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CITY OF
EDMONDS
N: APP(it'ant Subject to Plan Check Fee
DATE /
775-2525
s
This Permit covers work to be done on private property ONLY.
Any co nstructlOn on the public domain (curbs, sidewalks, driveways,
ORIGINAL - Filr YELLOW - lutipr�ua
marquees, etc.) will require separate permission.
PINK - Olvncr GOLD - Avo� ,,r
CITY OF
EDMONDS
DATE
NOT):: Applicant Subject to Plat, Clicck Fee 775-2525
This Permit covers work to be done on private property ONLY. ORIGINAL - Ric YELLOW - InspeUor ,
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission. PINK - Owner COLD - Assesr
e
CC",
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BUILDING DEPARTMENT
Applicant Fill\i
USE PERMIT1 •, ., t '�
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PERMIT APPLICATION
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REPAIR ❑POINT.
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NUMBER OF STORIES
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NATURE OF WORK TO.BE DONE
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VALUATION FEE
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I hereby acknowledge that I have read file appllcalion; that the In-
TOTAL AMOUNT DUE _ ----
forma [lan given IS correct; and that I am the owner, or the duly suther-
Ized agent or the owner. I agree to ...ply with city d t rlato Iowa ergo•
thereby. no
ATTENTION
APPLICATION APPROVAL
Taring construction; and In doing the work sulhorizrd person
Will be employed In Violation Or the Labor Code Of the State of Washington
THIS PERMIT
This application is not a permit until
rel8tmg to Workmen's Compeneatlon Iasaeenu.
AUTHORIZES
signed by the Building Official or his Dep
-
NOTE: Permit limit One Year which
ONLY THE
uty: and fees are paid, and receipt is Be
I
-IN Bt DINGS Shall
shall De completed Nnety days: MOVED -IN SuILB{N0a shell De eom-
WORK NOTED
ltnowledged in apace provided.
e.
plated In etc months.)
-
INSPECTION
R
SIGNATU RE;(OWNER OR AGENT) DATE SIGNED
DEPARTMENT
DIRECTOR'S SIGNATURE.
CITY OF
EDMONDS
DATE
NOT):: Applicant Subject to Plat, Clicck Fee 775-2525
This Permit covers work to be done on private property ONLY. ORIGINAL - Ric YELLOW - InspeUor ,
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission. PINK - Owner COLD - Assesr
e