650442.pdf.r
GILDING DEPARTMENT I ApplicantFlll
PERMIT APPLICATION Inside Heavy Lines
LAME (OR NAME OF BUSINESS)
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NUMBER OF
❑ NF)W ❑ ❑ SIGN
q ❑ ADD I DEMOLISH I ❑ FENCE I
n ALTER RESIDENTIAL NUMBER OF
DWELLING
C a REPAIR I � NON-RESIDENTIAL I UNITS
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I hereby ...enawledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state lawn 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 Workmen's Compensation Insurance.
• (Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
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NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY,
Any construction on the public domain (curbs, sidewalks, drlrswsyn,
marquees, etc.) will require septuete pernllselon,
❑ NO
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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PERMIT NUMBER
INSTRUCTION STREET IMPROVED
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OCCUPANCY GROUP
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VALUATION
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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
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receipt is acknowledged in space provided.