660349.pdff
BUILDIN
PERMIT
NAME ( It N�
F'1 Val
20
c_
DEPARTMENT
APPLICATION
0"
Applicant Fill
Inside Heavy Lines
Alt i
APHONE NUMBER
c.
-Description of Property (Show Below or Attach Four Copies)
pc.S
F.110)91
ALTER
REPAIR
SIGN
FENCE
RESIDENTIAL NUMBER OF
DWELLING
NON-RESIDENTIAL I UNITS
BUILDING
1
VALUATION
'1i
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT do GAS LINE
*
MIES
PERMIT FEE
PERMIT
6
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
I hereby acknowledge that I have read this application; that the in-
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 lawn 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 Your be completed in ninety days.)
r/,21/1l
NOTE: ApplicanF Subject to Plan Check Pee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
8 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
APPLICATION APPROVAL j
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.
—BS7�GTOR'8 SIGN T
w
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