650343.pdfa
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
110 I
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MA LING ADDRESS
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CITY TELEPHONE NUMB
0 t2m oAf 1) .5 1
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ADDRESS
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CITY
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or
P&-V- 70 6,
/Y c!14 aj ky 57LZz. 1A, - -23o
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k:/2 -AI12,�V V.�W�j 5c--c-19' 71 P7 &�2
ke- c57:? 01 - 0e.-R,1_ 0V4&/<1-- A-A__fj_�o
e" O-e f- ax 0ho 1) 1) C�, 6 ��
VORK TO BE DONE
14-19 jg,, tvvv -7—r-, S�-illlyCe-
NEW SIGN
9 0 1:1 SH
12 ADD I DEMOLI FENCE
0
0 9L ALTER 'IAL NUMBER OF
REPAIR RESIDENT DWELLING
NON-RESII UNITS
I hereby acknowledge that I have read this application; that the in-
formation given to 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.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
A �G
SIGNA.TURE, (OWNER OR AGENT) DATE71GN
M mm
NOTE: Applicant Subjcct to Plan
This permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways.
marquees, etc-) will require separate Permimshms.
PERMIT
NUMBER 650343
4-
ONE LOT AREA OIL=
— / -I_- [] YES rl NO 0
r BUILDING ��A cE NUMBER
1 1 V7 ;7f I
FT�A I 1� 04
0 YES
[3 NO
BUILDING
1
VALUATION
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
[] YES 0 NO
FM_
7 =—
M
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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 aclmowledged in space provided.
T R'S SIN
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DATE
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