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PROPOSED USE
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PLAN CHECK
NO.
VALUATION FEE
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ABUTTING STREETS)
BUILDING
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TOTAL AMOUNT DUE
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ATTENTION
APPLICATION APPROVAL
will be employed In Violation or the Labor Code at the State of Washington
THIS PERMIT
relatlag to Workmen's Compensation Insurance.
AUTHORIZES
This application is not a permit until
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signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
uty; and fees are paid, and receipt is ac-
shall be completed In ninety dsya: LIOVED-IN DVILDINGS shell be coin•
pleted In nix months,)
WORK NOTED
knowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
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CITY OF
EDMONDS
DATE
NOTE: Applicant Subject o Plan Check Fee
775-2525
This Permit covers work to be done an private property ONLY.
Any construction On the public domain (curbs, sidewalks, driveways,
ORIGINAL • F-Ilc YELLOW •Inspector
marquees, ate.) will require separate permission.
PINK - Owner COLD • As<essrr
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