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PLAN FILE NUMBER
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PERMIT 650256
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VALUATION
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PROPOSED USE
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AMOUNT DUE
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I hareby acknowledge that I have read this application; that the In-
formation given [a correct; and that I am the owner, or the duly author- ATTENTION APPLICATION APPROVAL
fted agent of the owner. I agree to comply with city and state laws regu- THIS PER1611T This application is not a permit until
lating construction: and In doing thu work authorized thereby, no person AUTIIOIUZE8
will be employed In violation of the Labor Coda of the State of Washington ONLY THE signed by the Director of Building Inspec.
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, arid
receipt is acknowledged in space provided,
NON: PERM11 LIMI1 %JINC UCIAM
INSPECTION
HIGNATURE 4OVT5kt Oft AGENT) i DATE SIGNED DIRECTOR'S SIGNATU�XE
DEPARTMENT
CITY OF
EDIVIONDS DATE
PLOT PLAN CIIECK & APPROVED PR 0-1107
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