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BUILDING DEPARTMENT Applicant FIR
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PERMIT
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PERMIT APPLICATION Inside Heavy Lines
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STATE/ - LICENSE NUMMUM CITY 115JURNFROW
Legal Description of Property (Show Below or Attach Four Copies)
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PLAN CHECK1911 Zx
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VALUATION
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BUILDING PERMIT
FEE
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PLUMBING
PERMIT FEE
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PERMIT FEE
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DEMOLISH FENCE
NUMBER OF STORIES
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DEMOLITION
PERMIT FEE
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REPAIR I DWELLING
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PLAN CHECK
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AMOUNT DUE
I hereby acknowledge that I have read this application; that the in- AWENTION
formation given to 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- THIS PERMIT
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed in violation Of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year bo completed In ninety days.) INSPECTION
SIGNAT jRE (OWNER OR AGENT) SIGNED DEPARTMENT
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CITY OF
6m6oim EDMONDS
NOTE: Applicant Svbject to Plan Check Fee pit 6.1107
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 permlashm.
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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.
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