650372.pdfBUILDING DEPARTMENT I Applicant IM
PERMIT APPLICATION Inside Heavy I[Anes
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NEW I DEE] SRI LJ SIGN ._2
ADD Mozz EJ FENCE
ALTEM RESIDENTIA.1, DWELLING
REPAIR NON-RESIDENTIAL I UWNJIMT13SER OF
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
fted agent of the owner. I agree to comply with city and state laws regu-
istins conedruction; and irk doing the work authorized thereby, no person
Will be employed in violation of the Labor Code of the State Of WashineOn
relating to WorkmeWo Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Your be completed In ninety days.)
3IGNATJJRE (yWNER Ult Auz"W) DATE SIGNED
ez//6-71( 6 ::�� 10/- 2e-t'.)
NOTE: APPlicant Subject to Plan Check Fee
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OF
YES C3 NO
BUILDING
I
VALUATION
13UIMING PER7
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
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PERMIT FEE
-71
PLAN CHECK
—FEE-
8 1 AMOUNT DUE
ATTENTION
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AUTHORIMS
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
YES 13 NO "'I
NUA7
,�IURN—CE NUMBEIR
ER
[] YES 13 NO
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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
recelut is aclmowledged In space provided.
This Permit coven work to be done on private Welty ONLY -
Any construction on the public domain (curbso sidewalks, driv-WAYN, FILE
marquaes, etc.) will require mparate permission.
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