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PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER — 660408
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS 0"(2 .- /j$ )
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PERMIT NUMBER
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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-
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.
ll,,,pl Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
8 ATURE (0 ER GENT) DATE SIGNED
NOTE: Appfican7ubject to Plan Check Fee
—�Fj,j. wrk t,) be done on private property ONLY.
Any construction on the public domaln (curbs. sidewalks, driveways,
marquees, etc.) will require meparnte permission.
0 YES
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BUILDING
VALUATION
BUILDING PERMIT
FEE
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
81
AMOUNT DUE_
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 6.1107
[3 YES [3 No
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.
FILE
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