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ADDRESS 721 Elm Place West
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Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY
❑YES
NEW
WORK REQ'D
❑ NO
Lot 4 Elm View Addition— Div. C.
UNDERGROUND
WIRING REQ'D
YES
❑ NO
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tormatlon Riven is Correct; and that I am the owner, or the duly author•
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REMARKS
ATTENTION
NUMBER OF STORIES
NUMBER OF
THIS PERMIT
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AUTHORIZES
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NATURE OF WORK TO BE DONE
SIGNED
DEPARTMENT
New Residence
JDATE
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CITY OF
VALUATION FEE
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I hereby acknowledge that I have read this application: that the In-
TOTAL AMOUNT DUE
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tormatlon Riven is Correct; and that I am the owner, or the duly author•
Istd agent of the owner. I agree to comply with city and alit* lawn rein-
thereby, no
ATTENTION
APPLICATION APPROVAL
leting con.INCtlaa; and In doing the work authorised person
will be employed in violation of the tabor Code of the Slate of Washington
THIS PERMIT
This application Is not a permit until
relsling to Workman's Compensation Ieemrauee.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (E.Cept DEMOLIT10Ne which
ONLY THE
NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In nlosty days; blOVED•IN BUILDINGS shall be com•
WORK
linowledged in Space provided.
pleted In .Ig month..)
INSPECTION
SIGNATURE (OWNER OR AGENT)
SIGNED
DEPARTMENT
DIRECT 'S SI AT RE
JDATE
C "13- 7
CITY OF
666
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EDMONDS
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GATE
NOTE: Applicant Subject to Plait C Teck Fee
775-2525
This Permit Covers work to be done on private property ONLY.
ORIGINAL - File YELLOW -, In;pecror
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, air..) will rCgaire Separate permission.
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