680306.pdf• C
BUILDING DEPARTMENT
PERMIT APPLICATION
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RESIDENTIAL ICI GA8
L j LINE
NON-RESIDENTIAL ❑ SIGN
❑RETAINING
DEMOLISH WALL
EXCAVATE FENCE
OR FELL (......... A .........
PY.)
IPRE -MOVE SWIM
INSP. POOL
.IES NUMBER OF
DWELLING
d /V LS� UNITS
NATURE OF WORK TO BE DONE
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I 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-
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 Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
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NOTE: APPlicant Subject to Plan Check Fee
This Permlt covers
work to
be done
on Private Property ONLY.
Any construction on
the Pablo
domain
(curbs, sldewaiks, driveways,
marquees#
etas) win
require
separate permisslon,
ON KROLL HAP NO.: I PERMIT 680306
DRESS
EXISTING STREET R/W ............FT.
COMP. PLAN ST, R/W ............PT.
Plan Check No, .................
BUILDING
PLUMBING
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
:,OWMWJ, .,
Valuation
Fee
ATTENTION I APPLICATION APPROVAL
No.
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in apace provided,
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR e-1101
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