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ROLL MAP NO.: 0UILDINa
PER>� 660331
BUILDING
ro BE DONNE 1 VALUATION
�`� / ?`� • / 2 BUILDING PERMIT
FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
NUMBER OF STORIES
NEW SIGN BIGN PERMIT
b FEE
ADD DEMOLISH FENCE DEMOLITION
I NUMBER OF g PERMIT FEE
ALTER I RESIDENTIAL DWELLING
PLAN CHE6
REPAIR I I NON-RESIDENTIAL UNITS 7 FEE
/��..E 8 I AMOUNT DUE
I hereby acknowledge that I have read this appllcaAn; that the in ATTENTION
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner, I agree to comply with city and state laws regu- THIS PERMIT
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance, WORK NOTED
(Except Demolitions which shall
NOTE: Permit Lima One Year be completed in ninety days.) INSPECTION
iIGNATURE (OWNER OR AGENT) DATE SIGNED
e � DEPARTMENT
- f / / L CITY OF
EDMONDS
NOT : APPlicant Subject to Plan Check Fee PR 6-1107
This Permit coven work to be done on private property ONLY.
Any eoastrnarq eess etc.) will rMdyren separate ppermisslaadrhrowaye,
J
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 acknowledged in space provided,
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