650321.pdfWnJ�JIIVILDING DIPARTMINT Applicant FM
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VALUATION
BUILDING PERMIT
2 FEE
NEW I I " SIGN I
ADD DEMOLISH 11:3 FENCE I
ALTER S"RESIDENTIAL NUMBER OF
DWELLING
REPAIR IF] NON-RESII UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In correct: and that I am the owner. or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
uONATURE ER oft AP414T)
NOTE: Applicant Subject to Plan Check- Fee
_jhl% Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permiRsion.
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
I'n 6-1107
PERMIT
NUMBER
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VACANT!
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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.
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RECORD OF INSPECTIONS
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Date Pd��ed
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Foundation
Plumbing (Partial)
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