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ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the stale of Wuhington
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NAME
FRONT SIDE REAR FRONT HIDE REAR
relating to Workmea'e Compensation Insurance.
This application 1s not a permit until
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PR 8.1107
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Plan chat], No .....................
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BUILDING
PROPOS D USE
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PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
Gov
FENCE
SIGN
tRETAINING
WALL
I
N
SWIMMING POOL
DEMOLITION
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUEe
I hereby acknowledge et I have rend this aDDlleatlan; that the Io-
mIs
form thin given correct; and that I a a the ."at. or the duly author -
Iced ,gent et Ne owner. I agree to comD1Y with city and Stals lave rogu-
Intlag construction; and 1p doing the work auth,rlge6 thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the stale of Wuhington
THUS PERMITf
relating to Workmea'e Compensation Insurance.
This application 1s not a permit until
-----
AUTHORIZER
ONLY
Bred b the Building Official or his Dep -
Yc
NOTE: Permit limit One Year (Except DEMOLITIONS which
THE
UtY; fees
-
shell be completed meaty days; OVER -1N HUII.DINOg shall be oom-
WORK NOTED
and are paid, and receipt is ac -
plated In el: months.)
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knowledged In space provided.
sl T RE (ONNER OR 6E ) DATE BIOMED
INSPECTION
DIRECTOR' s GNA
DEPARTMENT
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CITY OF
EDMONDS
DATE
N E:ikinIt Subject to Plan Check Fee
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This Parma cm�<ro work to De don n private property ONLY.
PR 8.1107
.Any c,netruct]aa an the public domain (curb., sidewalks, drlvnwayn,
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Foundation
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Plumbing (Partial)
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(Rough) 3 �' t@
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Furnace & Fuel Lines
Final