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TELEPHONE NUMBER
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STATE LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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BUILDING DEPARTMENT
Applicant Fill
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PERMIT APPLICATION
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TELEPHONE NUMBER
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indicated on .Standard Dw4. No.
NAME
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I HERVICE SIZE
I SERVICE SIZE
of
CITY
TELEPHONE NUMBER
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STATE LICENSE NUMBER
CITY -LICENSE NUMBER
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ADD ❑ DEMOLISH El ETWAINlNC
Legal Description of Property (Show Below or Attach Four Copies)
H LD BE CODED 31.04.
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Y THIS PROPERTY
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REMARKS Driveway slopes not to exceed those
indicated on .Standard Dw4. No.
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REMARKS
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THIS SITE IS LOCATED IN THE CITY
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Valuation
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Receipt No.
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BUILDING
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4 PROPOSED USE
PLUMBING
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w
O PLOT PLAN (Indicate Huliding setbaaka, abutting street.)
HEAT A GAS LINE
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9
FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
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i hereby acknowledge that I have read this application; that the In-
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'
[ormatlon given Is carred; and that I am the owner, or the duly author•
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ized agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
IaUng construction; and In doing the Work authorized thereby, no person
w•III be employed In Violation of the Lobar Code of the State of Waahmitton
TITIN PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except OEMOLITIONB which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is aC-
ehNl be completed In ninety days; MOVED -IN BUILDINGS shall be com•
Imowledged in space provided.
-
pletcd In sls months.)
SIG UItE (OWN t OR ENT) DATE SIGNED
INSPECTION
D RE 'S ON URE
-
DEPARTMENT
i i_fl•-'
CITY OF
y _
EDMONDS
DTE
NOTE: Ahhlicant Subject to Plats Check Fee
775-2525
This 1'rnnit r ..,it to be done an private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. Ste.) will require separate pernueslon.
FILE
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