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BUILDING. DEPARTMENT Applicant FIR
Inside Heavy Lines
PERMIT APPLICA
W:7
NAME (OR NAME OF BUSINESS)
HAP NO.:
0
PERMIT
NUMBER
13 YES
0 NO 01 i
UMB_0_R_
7 REMARKS
IL�( Lin — IQ In ]2 PHONE NUMBER METER SIZE SERVICE SIZE CLEARANC r 04
CITY
Q11 Q. I - A tA
STATE LICEN13E NUMBER CITY LICENSE NUMBER
TYPE CONNECTION
Legal Description of Property (Show Below or Attach Four Copies) PERC. TEST PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES El NO
SPECIAL INSPECTORREQUIRED OCCUPANCY GROUP
YES 13 NO
PLAN CHECKED 33Y
VALUATIO14 TOTAL rElf
BUILDING
WORK TO BE DONE VALUATION z
BUILDING PERMIT
A FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
NUMBER OF STORIES 4 PERMIT FEE
NEW SIGN SIGN PERMIT
El 5 FEE
A.DD DEMOLI FENCE DEMOLITION
NUMBER OF 6 PERMIT FEE
ALTER RESIDENTIAL
DWELLING PLAN CHECK
REPAIR NON-RESIDENTIAL I UNITS 7 FEE
PROPOSED USE 8 AMOUNT DUE L
I hereby acknowledge that I have read thin application; that the In-
formation given is correct; and that I am the owner, or the duly author- ATTENTION APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu- Tills PER311T This application is not a pernilt until
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec-
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
(Except Demolitions which shall receipt is acknowledged in space provided.
NOTE: Permit Limit One Year be completed In ninety days.) In
SIGNATURE (OWNER OR AGENT) DATE 81UNNU INSPECTION IRE TOR'S 81 NKTURE
DEPARTMENT /
_k TE
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 0-1107
Tills Permit covers work to tm done an private property ONLY.
Any construction on the public domain (curbs, sidewulks, driveways, FILE
marquees, etc.) will require sepmritte permission.