650476.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION 11askle Heavy Lines
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u NEW ❑ U SIGN
q ADD DE] OLISR, FENCE
Ci
n ALTER I RESIDENTIAL I NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
I hereby acknowledge that I have reed this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
lzed agent of the Owner. I agree to comply with city and state laws regu-
Iating construction; and In doing the work authorized thereby, no person
win 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 bo completed In ninety days.)
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v NOTE: Applicant Subject to Plan Chick Fee
This Perudt coven
work to
be done
on private property ONLY,
Any construction on
the public
domain
(curbs, sidewalks, driveways,
marquees,
etc,) will
rrqulre
separate permission,
BUILDING
I VALUATION
S 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR a-1107
VERIFIED BY �..'
PERMIT NUMBER I
INSTRUCTION - STREET IMPROVED.
0 YES 13NO �:.
aum I OCCUPANCY GROUP i r
r ,
VALUATION TOTAL Felt
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APPLICATION APPROVAL I
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.
CTOR'S 8 URE
FILE Ij • i
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