660110.pdf11-UILDING DEPARTMENT
PERMIT APPLICATION
XXVIII (OR NAME 014k"153)
GAD RE138
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Applicant 011
Inside Heavy Lines
'ff-C Lilt
or
" SIGN
NAEDWD I DEMPLIS11 I M FENCE
LJ,...KLTER LJ RESIDENTIAL NUMBER OF
"r— DWELJaING
IR I ff?"NON-RESIDENTIAL UNITS
PRO ED U&I.W
—44000'
e I hereby ack owledge that I have read this application; that th in-
formation given in correct; and that I am the owner, or the duly alor-
Ized 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
reIr-Ung to W0rkmAn'5 COUIPOW13110o, Insurance'
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
NOTE: Applicant Subject to Plan Check Fee
16
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6601 i 0
- NO.: 15UHAULNEk
PERMIT
6601 i 0
NUM13ER
STREET SETBACK
RmAR YARD SEM
LOT AREA
VACANT Or=
1
0 YES 0 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
a I AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
YES
[3 NO
':�7 &12e)
APPLICATION APPROVAL
This application is not a pernilt, until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acimowledged in space provided.
V
This pem-dg coven work to be done on private property ONLY.
Any constructins an the public domain (curbs, sidewalks, driveways, FILE
marquees, etc.) will require separate PermINA10n-
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