660530.pdf1, 1 LP . ' I s',ING DEPARTMENT Applicant Fill
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717tion of Property (S I how Below or Attach Four Copies)
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BUILUMU
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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 Workman's Compensation Insurance.
llxccpt Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
3IGNATURE (OWNER OR AGE DATE SIGNED
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NOTE: Applicant Snbject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, aldewalks, drivewayn,
marquess, etc.) will require separate permission.
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BUILDING
VALUATION
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FEE
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PERMIT FEE
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SIGN PERMIT
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AUTHORIZES
ONLY THE
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INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
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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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