660388.pdfBUILDING DEPARTMENT Applicant FIB
Inside Heavy Lines
L D I N '
PE"RMIT APPLICATION
FNAMS (OR 14AMID OF BUSINESS)
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BUILDING
PERMIT
NUM13ER 660388
1AUM "EAR YARD 5W
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METER SIZE BER CX SIZE
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NEW M " SFIEGNNCE
ADD DEMOLISH
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
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 laws regu-
I&ting 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.)
DATE SIGNED
NOTE: Applicant Subjcct to Plan Check Fee
9�ws —Fernut covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, oldew.rOks, driveways,
marquees, etc.) will require separate pern,18910".
BUILDING
I I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
—
IiEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTIIOIUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
11n 0-1107
[] YES [3 NO
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APPLICATION APPROVAL
This application is not a permit Un
signed by the Director of Building InsjX
tion, or his deputy; and fees are paid, EL
receipt Is acknowledged In space providi
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