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BUILDING DEPARTMENT ZONE DC NUMBER
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PERMIT APPLICATION Inside Heavy Lines
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PLANNING DF.T. P VAL —3-31-75-
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DEMOLITION
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STATE LICENSE
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EXCAVATION OR FILL
Legal Description
ol Property (She Below or Attach Four COPlral
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formation given is correct; and that I am the owner, duty the duly author-
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TYPE CONNECTIO V R1FI D Y
ATTENTION
APPLICATION APPROVAL
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will be employed In violation at the Labor Code or the Slate of Washington
THIS PERMIT
This application is not a permit until
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AUTHORIZES
Signed by the Building Official OT his Dep -
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ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
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DEPARTMENT
REMARKS
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FIRE ZONE TYPE OO/F/•CONSTR TION STREET IMPROVED
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This FeralFeralcovers work to be done an private property ONLY.
775-2525
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marletc.) will regmre eeparale Dermleelon.
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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eRESIDENTIAL GAS
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PLAN CHECK `D THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL filON
4� OF EDMONDS. LOCAL SALES TAX
SHOULD BE C ODED 31.04.
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NUMBER
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N URE OF WOR TO BE DONE
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Valuation
Fee Receipt No.
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Check No .................
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EXCAVATION OR FILL
1 hereby acknowledge lent I have read this application; that les In-
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TOTAL AMOUNT DUE
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formation given is correct; and that I am the owner, duty the duly author-
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tzed agent o[ the owner. I agree to comply with city and elate taws ngu-
Mile. construction; and In doing the work authorized thereby, no Person
ATTENTION
APPLICATION APPROVAL
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will be employed In violation at the Labor Code or the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official OT his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS witch
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be completed in ninety days; MOVED -IN BUILDINGS shell be coin•
iIROWI¢d ed in
g pace provided.
VWed In six ma
B ATU O GENT DATE 810 EU
INSPECTSON
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DEPARTMENT
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CITY OF
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NOTE: Applica t Slthject to Plan Check Fee
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DATE tg
This FeralFeralcovers work to be done an private property ONLY.
775-2525
Any Coast ..tion on the public domain (curbs, eldewalke, ye,
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marletc.) will regmre eeparale Dermleelon.
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