660455.pdf1DING DEPARTMENT
00
fE MIT APPLICATION
JOR E OF BUSINESS)
y
qUALLING ADDRESS
I -Description of Property (show Below or
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Applicant FM
Inside Heavy Lines
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NUMBER -OF STOIRULEH
SIGN 11 ST MEM
94 NADWD I DEMOLISH I [:] FENCE I
F-1 ALTER RESIDENTIAL NUMBER OF
DWELLING
RZIPAIR NON-RESIDENTIAL UNITS I
I bereby 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 rtgu-
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 Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
IFIGNA URE (OWNER OJ�,,&GENT) DATE SIGNED
NOTE: Applicant Subject to Plait Check Fee
qi;il Perm —it covers work to be done an private property ONLY.
Any construction On the Public domain (curbs, sidewalks, driveways,
marquess. etc.) will require separate Permission.
I
I
0 YES 13 NO
BUILDING
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
3 1 AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR G-1107
[3 YES E3 NO
[3 YES [3 NO
Z
N
APPLICATION APPROVAL
This application is not a pern-At until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged In space provided.
InLE
3o, 1
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