650464.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
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Applicant FIJI
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A
iNEW SIGN
A ADD I DEMOLISH --Cr
ALTER 91 RESIDENTIAL NUMBER OF
DWELLING
F-1 REPAIRI F� NON -RESIDE: UNITS
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I hereby acknowledge that I have read this 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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Cimit One Year be completed In ninety days.)
3IGNATURE (OW141un vn �IDATE SIGNED
// I It— ;L2, —A�
NOTE: Applicant Subject to Plan Check Fee
—im—ppermit covers work to be done on private property ONLA.
Any construction on the public domain (curbs, sidewalks, drivewaYs,
marquees, etc.) will require separate permission.
DDRESS
YARD SETBACK STREJ
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I
PERMIT
NUMBER
6504
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[3 NO 10
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REMARKS( 6
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SIZE I SERVICE ME CLEARANCE C
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TYP ECTION ED BY
PERMITJNUMBER
PERC. TEST I I I
SPECIAL INSPECTOR REQUIRI
[:] YES a
PLAN CHECKED By
BUILDING
1 VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
SIGN PERMIT
5 FEE
DEMOLJTION
6 PERMIT FEE
PLAN CHECK
71 FEE
I-] YES El rTo
'_2 -j- , a 0 0
Z
8 AMOUNT DUE 0
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHOMZES signed by the Director of Building InsPec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION DIRECTOR'S SIGNATUY�,,,,,
DEPARTMENT
CITY OF
D
EDMONDS
PH 6-1107
FILE
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