670439.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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I Itereby acknowledge that I have read thin 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 "a of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE31OLITIONS which
shell be completed In ninety days; MOVED -IN BUILDINGS shall be cota-
plated In six months.)
NOTE: Applicant Subject to Plan Cbeck Fee
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 permission.
ATTENTION
THIS FEIMUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
0 YES
[3 NO
DEFICIENCY THIS PROPERTY
0 YES [:] NO
Valuation I Fee
0�0 1 .3.
N
No.
I K40 11
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building official or lAs Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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