660173.pdfPOSTED ON KROLL MAP NO7
BUILDING DEPARTMENT
Applicant FIB
JOB ADDRESS
inside Heavy Lines
"S PERMIT APPLICATION
(OR NAME 0 ISINE;8; A?
SIDE YARD SETBACK STREE
ADDRESS /0
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TELEPHONE NUMB
51411
REMARKS
U B R
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CITY LICENSE NUMBER
TYPE CONNEC
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rty (Show Below or Attach Four Copies)
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dNE
PERC. TEB
FIRE ZONE
TYPE OF col
SPECTOR REQUL
[3 YES
5.!
NEW I [:] I " SIGN
ADD DEMOLISH 10 FENCE
ALTER RESIDENTIAL NUMBER OF
DWELLING
1:1 REPAIR E] NON-RESIDENTIAL UNITS
PROPOS USE
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 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'$ Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
NT DATE IGNED
]ale
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
marquess, etc.) will require separate Permission.
I I 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
T
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
BUI DING
PERMIT
NUMBER
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WINWMMA�M
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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