660041.pdfBUILDING DEPARTMENT Applicant Fill
PFRMIT APPLICATION Inside Heavy Lines
M
NAME (OR NAME OF B
S
NAILING "WEEbb
ICTATE �LICENSE I
Tagal scription,
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) . (.,,ILl .
-1 �LEPJ[16NE NUMj
7 4'�l — / -3 -7
or A
NEW
M
I
" SIGN
I
ADD
DEMOLISH
113
PENCE
PQ
a
7fl
ALTER
RESIDENTIAL
NUMBER or
7
REPAIR
10
[ �
NON-RESII
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In.
formatiou given In 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 W&Bhlngton
relating to Workmen's Compensation Insurance.
lExcept Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
IIGNATU (OWNER OR AGENT) DATE SIGNED
I . 4 n /� I � /;�
// , I- � -J/1
NOTE: Applicant Snbject to Plan Check Fee
This Permit covers work to be done oA private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
........ . .. ..... . . .. . . .
10
0 YES 0 NO
PERMIT
NUMBER 660041
ET SETIJACK HEAR yARDISETBAC
VACANT SITE
0 YES [3 NO 0
DING AREA I VARIANCE NU
13 YES 0 NO
N
BUILDING
I VALUATION
BUILDING PERMIT
2 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
APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES igned by the Director of Building Inspec-
ONLY THE S
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION
DEPARTMENT SDO '18 SIG RE
CITY OF
EDMONDS
PR 0-1107 X
FILE
I