760030.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
TYPE CONNECTION VERIFIED BY
❑ YES PERMIT N
❑ NO
SEPTIC SYSTEM
APPV D BY CITY ENG.
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REMARKS
GAS
RESIDENTIAL LINE ;EONE
❑ NON-RESIDENTIAL ❑ SIGN
❑ RETAINING
❑ DEMOLISH WALL
❑EXCAVATE FENCE
OR FILL ❑ ( X_FT) PRE -MOVE SWiMINSP. POOL
TIES NUMBER OF
DWELLING
UNITS
K TO BE -DONE A �• 1 d� mi
ABUTTING
PLAN CHECK
NO,
TYPE
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BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
nt of the owner. I agree to comply with city and Biala laws regu-
ATTENTION
construction; and In doing the work authorized thereby, no person
In violation of the Labor Code of the state of Washington
THIS PERMIT
employed
to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
L,t
: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
e completed In ninety days; MOVED -IN BUILDINGS shall be com-
In six months.)
INSPECTION
NED
URE (OWNER OR AGENT) D7as
DEPARTMENT
�CITY
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D
EDMONDS
NOT/:: Applicant Subject to Plan Check Fee
775-2525
This Permit covers work to be done on private property ONLY.
domain (curbs, sidewalks, driveways,
Any construction on the public
etc.) will require separate permission,
marquees,
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VALUATION I FEE
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
IIR CTOR'S SIGNATURE' .. .
)ATE
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