770660.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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770660
BDIVISION NO.
FT. DEFICIENCY THIS PROPERTY
FT. FT.
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❑ YES ❑ NO
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❑ ADD ❑ DEMOLISH ❑RETAINING REQUIRED
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REPAIR NSPNIOVE POOL
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IUMBER 77!::]NUMBER OF /
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i hereby acknowledge that I have read this application; that the in-1
formation given is correct; and that I am thelowc r and t e duly latvs author-
ized agent of the owner. I agree to comply noregu-
lating construction; and in doing the work authorized thereby, person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be comp) in six DATE SIGNED months.)
NR
SIGATUE (OWNER OR AGENT)
CGS
NOTE: Applicant Subject to Plait 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
71901
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BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
PLANNING VI BY
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SIDE REAR
ONSTRU ION CQ
gq OCCUPANCY
GROUP
THIS SITE IS LOCAT
OF EDMONDS. LOC
SHOULD BE CODED
VALUATION
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❑ NO
FEE
LOAD
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L AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit
AUTHORIZES until signed by the Building Official or
ONLY THE his Deputy; and fees are paid, and
WORK NOTED receipt is acknowledged in space pro-
v' d.
INSPECTION D EC O SIGNA URE
DEPARTMENT '
CITY OF
EDMONDS TE
775-2525 f0 C
ORIGINAL - File YELLOW - Inspector
GOLD • Assessor PINK • Owner
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