660337.pdfD ON KROLL MAP NO-: BUILDIN(
BVILDING DEPARTMENT PERMIT
Applicant F1U NUM33ER
ION Inside Heavy Lines JOBADDRESS
PERMIT APPLICAT
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DEMOLISH
11:1 FENCE
ALTER
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NUMBER OF
REPAIR
NON-REBIDENTIAL
DWELLING
UNITS
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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-
ized agent of the owner. I agree to comply with city and state lawn regu-
iating 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.)
XTE 81—GNEII
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NOTE: Applicant Subjcct to Plan Chcck Fcc
-This Pernalt covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
0 YES
[3 NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CffY OF
EDMONDS
PH 6-1107
660337
7
a YES
Rul
[3 YES a No
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APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building InaNc-
tion, or his deputy; and fees are paid, and
receipt Is aelmowledged in space provided.
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