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REMARKS
® NEW RESIDENTIAL LINE
❑ NON-RESIOENTIAL SIGN
❑ ADD
❑ ❑ RETAINING
DEMOLISH WALL
❑ ALTER EXCAVATE FENCE
❑ OR FILL 1_ x_F11
PRE -MOVE SWIM
❑ REPAIR ❑ INSP, OPOOL
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PERMIT APPLICATIOPI Inside Heavy Lines
ADDRESS
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NATURE OF WORK TO BE DONE
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WORK REO'D NO
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REMARKS
® NEW RESIDENTIAL LINE
❑ NON-RESIOENTIAL SIGN
❑ ADD
❑ ❑ RETAINING
DEMOLISH WALL
❑ ALTER EXCAVATE FENCE
❑ OR FILL 1_ x_F11
PRE -MOVE SWIM
❑ REPAIR ❑ INSP, OPOOL
FIRE ZONE TYPE OF CONSTR CTION
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SPECIAL INSPECTO AREA
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❑ YES NO
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OF EDMONDS. LOCAL SALES TAX
SHDU D BE DE03
MAR
— 2-% /if
NUMBER OF STORIES
NUMBER OF
DWELLING /
UNITS
HEAT & GAS LINE
NATURE OF WORK TO BE DONE
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I hereby acknowledge that I have read this Application; that the In-
formation given he correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to Comply with city and state taws reg.-
lating "'itructhm; and la doing the work Authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In Violation Of the Labor Code of the State of Washington
Insurance.
THIS PERMIT
This application Is not a permit Until
relating to workmen's Compensation
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except nE1tomltzoNS which
ONLY THE
uty; and fees are paid, and receipt is aC-
shell be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
lfnowledged in apace provided.
plrted In six months.)
INSPECTION
SIG ATU E WNER OR A E T) GATE .IG ED
DEPARTMENT
DIRE R'B SAGN ATU E / !
CITY OF
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C / W
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EDMONOS
GATE
NOTE: Applicant Subject to Platt Ckeck Fee
775-2525
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - F,1c YELLOW - Inspeclor
marquees, eta) will require separate permission,
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