660146.pdfFNEBUILDING DEPARTMENT Appllcant M
Inside Heavy Lines
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ERMIT APPLICATION
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CITY TELEPHONE NUMBER
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CITY KELEPHONE NUMBFX
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NEDWD I DEMMOLISH
SIGN
FENCE
0
ALTER
REPAIRI
RESIDENTIAL
NON-RESIDENTIALI
NUMBER OF
DWELLING
UNITS
2—
--14-1(
El YES
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly allthar-
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
relating to Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIONAT JRE (OWNER OR AGENT) DATE SIGNED
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NOTE: Applicant Subject to Plan Check Fee
_ji�s —Pernilt oovm work to be done an private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways.
nuLrquees, etc.) will require separate pern'181100.
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P NO.: BUILDING
PERMIT
I NUMBER
/_ I
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
6
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
13 NO
rUMBER
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0
0
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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 aclinowledged in space provided.
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