660230.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME 7OR 14MM OF BUSINESS)
CITY OF EDMONDS
NG ADDRESS
250 - 5th Ave. No.
CITY
Edmonds, Wash
P1
NAME
ADDRESS
CITY
TE
NAME
ADDRESS
CITY
TIE
STATE LICENSE NUMBER
CI
Legal Description of Property (Show Below or
I
Applicant FBI
Inside Heavy lAnes
NEW
ADD
DEMOLISH
Bior
FENCE
ElALTER
N RESIDENTIAL
BER OF
rWME t
REPAIR
I NON-RESIDENTIAL
M IN G
I UNITS
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 -
I hereby
L"on give
lzed agent of the owner. I agree to comply with city and state laws regu-
4
lating construction; and in doing the work authorized thereby, no person
J
� will be employed In violation of the Labor Code of the State of Washington
am
relating to Workmews compensation Insurance.
lati
NOT 81 (Except Demolitions which shall
OTE: Permit Limit One Your be completed in ninety days.)
'T
L—
iff—GNATURE (OWNER OR AGENT) DATErGN
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done ooprivate property ONLY.
Any construction on the public domsin (curb$. sidewalks, driveways,
marquees, etc.) will require separate permission.
YES [] NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
FEE
DEMOLITION
PERMIT I=
PLAN CHECK
7
FEE
rvw,'OACOPRY�0169
AT=NTION
TIUSPEPMIT
AUTHORIZES
ONLY THE
WORK NOTzD
rNSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
13 YES E3 NO
YES [3 NO
z
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