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121 5TH AVENUE NORTH - EDMONDS, WA 98020
�"c. 1890
PHONE: (425) 771-0220 - FAX: (425) 771-0221
DATE: Wednesday, November 14, 2012
PERMIT #: BLD20121046
PROJECT ADDRESS: 6918 163RD PL SW, EDMONDS
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6918 163RD PLACE SW
EDMONDS, WA 98026
(425)743-7315
*FEE SUMMARY:
Date
Description
Fee Amount
Paid
Balance Due
11/14/2012
X -Permit Surcharge Fee
$15.00
($15.00)
$0.00
11/14/2012
B -Building Permit - Other Fees
$65.00
($65.00)
$0.00
11/14/2012
B -Building Permit - Other Fees (QTY: 1)
$60.00
($60.00)
$0.00
11/14/2012
B -Building Permit - Other Fees (QTY: 1)
$65.00
($65.00)
$0,00
11/14/2012
B -State Building Code Surcharge (QTY: 1)
$15.00
($15M)
$0.00
Total Due: $220.00
($220.00)
$0.00
*FEES ARE ESTIM4 TED BASED ON INFORMATION PRO 14DED AT SUBMITTAL -SUBJECT TO CHANGE
PAYMENT TRANSACTIONS:
Date Receipt # Method/Payee Paid
11/14/2012 RECO56607 Auto /Roger Hertrich ($80.00)
X -Permit Surcharge Fee ($15.00)
B -Building Permit - Other Fees ($65.00)
11/14/2012 RECO56608 Auto /Four Seasons Roof ($140.00)
B -State Building Code Surcharge ($15.00)
B -Building Permit - Other Fees ($60.00)
B -Building Permit - Other Fees ($65.00)