760309.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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-ty (Show Below or Attach Four Copies) STREET AND/OR UTILITY El YES YES Z
WORK REQ'D ❑ NOf�
UNDERGROUND ❑YES /
/ WIRING REQ'D ❑ NO
h� TYPE CONNECTION VERIFIED BY
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SEPTIC SYSTEM I ❑ YES
APPVD BY CITY ENG. N ❑ NO
REMARKS tt
METER SIZE SERVICE SIZE CLEA RAt
❑ NEW RESIDENTIAL GAS
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NUMBER OF STORIES REMARKS
NUMBER OF
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NATUR Oli WORK TO BE DONE <:::00D. 0�5 0
I hereby acknowledge that I have read thin application; that the in.
formation given II correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city and state laws regu.
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Ins re. �N 5
NOTE: Permit Limit 0W7�luoa- - --
SIGNATU E (O E R AG NT) A DATE SIGNED
NOTE: Applicant Subject to Platt Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PLAN CHECK
NO,
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
L
ININGWALL
MING POOL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
NUMBER W
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NU W
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OF EDMONDS, LOCAL SALES TAX
CO YD. (,yl x c j
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VALUATION I FEE
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.
DIRECTOFI> SIG14FJTIARE
DATE V
-15 �7�
ORIGINAL - File YELLOW- Inspector
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