660115.pdfUILDING DEPARTMENT I Appllcaiitt Fill
PERMIT APPLICATION I Inside Heavy Lines
FTWM A rt-l" �03
i �'
I
/ V60
or
T� 11190
NEW
SIGN
NUMBER OF
ADD
DEMOLISH
PENCE
J
ALTER
RES113ENTUL
��ER
M
REPAIR
F� NON-RESIDENTIAL
GOP,
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to 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.
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 Workman's Compensation Insurance.
(Except Demolitions which oball
NOTE: Permit Limit One Your be completed in ninety days.)
3IGNATURE (OWNER 0 AGENT) DATE SIGNED
emt 13-10
V
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private ProPertY ONLY.
Any oonstruction on the public domain (curbs, sidewalks, driveways,
ma"uses, tic.) will require separate PerMIN510n.
PERIM
NUMBER 660115
/ 7 Z6 91 - 7j2 Ur
0 YES 0 NO
[3 YES 0 No
13 YES 13 NO
BUILDING
VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT &GAS LINE
4 PERMIT FEE
SIGN PERMIT
5 FEE
DEMOLITION
6 PERMIT I=
PLAN CHECK
7 FEE
s AMOUNT DUE I I :?, o� 1
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
FILE
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