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hereby acknowledge that I hove read this Application; that the In-
TOTAL AMOUNT DUE
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formation Riven le correct; and that I the owner, or the duly author-
ent of the owner. I agree to comply with city And state laws regu-
ATTENTION
eonstruetlon; and m dolag the work authorised thereby, no Berson
APPLICATION APPROVAL
employed In violation of the Labor Code of the State 0f Washington
THIS PERMIT
This application is not a permit until
rel us to Workmen's Compensation Insurance.
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AUTHORIZES
signed by the Building Official or his Dep -
: Permit Limit One Year (Except DEMOLITIDNa which
ONLY THE
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completed In nicely days; AIOVED•IN BUILDINGS shall he cem•
WORK NOTED
elx month..)
knowledged in space provided.
(OWN OR AGF�-1T)
GATE SIGNED
INSPECTIONURE
DEPARTMENT
DIRECTO ' IGNA RE
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
DATE / n
/ �' '7
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - hl, YELLOW - h,i,e, lnr
marquees, etc.) will require separate permission.
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REMARKS 'i
I hereby acknowledge that I have rend this application; that the In
TOTAL AMOUNT DUE
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SIGNATURE (OWNER OR AGENT) DATE SIGNED
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775-2525
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This Permit covers work to be done on private property ONLY.�OMC'INAL-
driveways,
REMARKS
ny construction on the public domain (curbs, sidewalks,
NUMBER OF STORIESNUMBER
OF
DWELLING4�ii
marquoes, ate.) will require separate permission.
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UNITS
NATURE OF WORK TO -BE DONE
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VALUATION FEE
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I hereby acknowledge that I have rend this application; that the In
TOTAL AMOUNT DUE
formnllan Riven U correct; and that I am the owner, or the duly antaor-
Ired agent or the owner. I agree to comply with city and slate Iaws regu-
'y
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
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THIS PERMIT
Thls application Is not a permit unit]
relating t0 Workin . CempeneaU
qUT HO RiZES
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signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
Utyl and fees are paid, and receipt is aC-
ehnll be completed In ninety date; 610VED-IN DOD.D[N09 shall be wm-
y ONL NOTED
knOWledg¢d 1n apace provided.
Neled In six months.)
INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
DIRECTOR'S SIGNATURE,
CITY OF
EDMONDSDA
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NOTE: Applicant Subject to Plait Geek Fee
775-2525
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This Permit covers work to be done on private property ONLY.�OMC'INAL-
driveways,
File YELLOW - Inspector
ny construction on the public domain (curbs, sidewalks,
PINK -Owner GOLD - Assessor
marquoes, ate.) will require separate permission.
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