650467.pdfgill KnOLL MAP NO.; BUILDING
I I PERMIT 650467
BUILDIIIG DEPARTMENT Appl1cant Fill _7 NUMBER
Inside Heavy ILInes JOB ADDRESS
APPLICATION
ij� �,,,PERMIT
(OR NAME OF BUJUNVOS)
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VARLALNCE NUMBER.
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Legal Descriptlon of Property
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jiFE OF CONSTRUCTION
STRI
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NEW
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SIGN
ADD
DEMOLISH El
FENCE
ALTER
-1
RESIDENTIAL
NUMBER OF
DWELLING
REPAIR
N1
UNITS
I hereby acknowledge that I have read this application: that the in-
formatlon given In correct; and that I am the owner, or the duly author-
lzod agent of the owner. I agree to comply with city and state laws regu-
latlng construction; mid 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.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
NOTE: Applicant
00'_
to Plan Check Fee
This Permit covers Work to bed one on private property ONLY.
Any construction on the public domain (curb$, sidewalks, drlvm&YO,
ullaqu"N' etc.) will M. luire separate permission.
0 YES 'P'NO
PLAN CHECKED BY
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
s
AMOUNT DUE
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
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APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
DIRECTOWS SIGNATURE
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