660006.pdfBUILDING DEPARTMENT
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ERMIT APPLICATION
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AILING ADD as
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Applicant Fill
Inside Heavy Lines
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NEW
SIGN
NUMBER OF STORIES
ADD
DEMOLISH
IE3 FENCE
ALTER
RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWIELLING
UNITS
I hereby acknowledge that I have read this application; that the In.
formation given is correct; and that I ain the Owner, or the dilly author-
lzed 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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be Completed in ninety days.)
IIGNATURE (OWNER OR AGENN DATE IGNED
NOTE: Applicant Subject to Plan Check Pee
This Permit covers work to be done on private property ONLY.
Any comtructlon an the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission.
[] YES
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EMILMS
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FE I,
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INS ECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
(3 YES
0 NO 1Z
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NR_
ow
0 YES 0 No
NMI
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 aclmowledged in space provided.
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