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G DEPARTMENT
. APPLICATION
Applicant Fill
Inside Heavy Liz
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N30 NUMBE
Legal Description Of Property (Show Below or Attach Four COPIC
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SIGN
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NUMBER OF
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DEMOLISH PENCE
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ALTER.
0 RESIDENTIAL
NU ER OF
REPAIR
1 F� NON-RESIDENTIAL
DWEBMING
I UNITS
I hereby acknowledge that I have read this application; that the In-
formailon 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-
laung 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.)
NOTE: APPlicant Subject to Plan Check Fee
This permit covers work to be done on, private property ONLY -
Any construction on the public domain (curbs, sidewalks. driveways,
mer,quees, etc.) will require separate permission.
RESS
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BUILDING
VALUATION
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BUILDING PERMIT
2
FEE
MB
PLUMBING
3
PERMIT FEE
FGAS
H:EEAT & ILZNIE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMO TION
6
PERMIT FEE
PLAN CHECK
7
FEE
81 AMOUNT DUE
ATTENTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
PERMIT
NUMBER
SETBACK
IM'A—.RYA
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[3 YE13 13 NO 0
TI_NGATrtEA
VARIANCE NUMBER
13 YE13
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APPLICATION APPROVAL
This application is not a perndt 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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