660441.pdfK77-., t
BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Heavy Lines
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NEW
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SIGN
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DEMOL113II
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ADD
FENCE
ALTER
RESIDENTIAL
NUMBER OF
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NON-RESII
DWELLING
I UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In 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 -a Compensation Insurance.
(Except Demolitions which shell
NOTE: Permit Limit One Year be completed In ninety days.)
jIGNTTURE (OWNER OR AGENT) DATE SIGIND
NOTE. A fflicant Subject an Check Fee
This permit covers work to be done on private PmPertY ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sepnrate permission.
0 YES
[] NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
Tins PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 6-1107
BUIL.DiNu .
PERMIT 660441
NUMBER
DA C
0 YES 0
VARIANCE NUMBER
[3 YES 0 NO
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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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FILE
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