650485.pdf0
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BUILDING DEPARTMENT I Applicant Fill '
PERMIT APPLICATION Inside Heavy Lines
JNA= (OR NAME OF BUSINESS)
G ADDRESS
XG-TLT-tf- W f�5.7-
ADDROBB
6 7"L
:OITY
At LAL.) Z'111
?P- 6 �
.5 cu .
TELEPHONE NUMBER
?/-L 6 — (Z 0 (�
or
[I YES
13 NO
WORK TO BE DONE
t/ e, o
1
BUILDING
VALUATION
BUILDING PERMIT
PEP
2
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
El SIGN
NUMBER OF STORIES
SIGN PERMIT
NEW
ElADD
DEMOLI sH
FENC E
5
FEE
DEMOLITION
PERMIT FEE
ALTER
RESIDENTIAL
OF 6
REPAIR
NON-RESIDENTIAL
DN=BER
ELLING
UNITS
—
PLAN CHECK
FEE
PROPOSED UBE
81
AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given is correct: and that I am the owner, or the duly author-
ATTENTION
fted agent of the owner. I agree to Comply with city and state lawL: 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.
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
NOTE: Permit Limit One Year (Except Demolitions which shall
be completed In ninety days..)
11GNATU P, —(OWNER ENT) DATE SIGNED
INSPECTION
ZOR
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6.1107
This Permit covers work to be done on private property ONLY.
Any constructim on the public donuAn (curbs, sidewalks, drlvmvnys,
ritarquees, etc.) will require separate permission.
PERMIT
NUMBER 650485
13 YES
I
NO 0
CBER
ow
[I YES El NO
I I 5�' 60-o I
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 acknowledged in space provided.
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