660043.pdfBUILDING DEPARTMENT Applicant F1U
PE RMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
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�AILING ADDRESS
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CITY
NUMBER
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NAME
ADORE 38
CITY
LEPHONE NUMBER
NAME
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TELEPHONE NUMBER
SE NUMBER
_RTATE LICEN UMBER
CITY LICENSE NUM13ER
Legal Description of Property (Show Below or Attach Four Copies)
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KROLL MAP NO.: BUILDING
PERMIT
NUMBER 660043
1 4 r
13 YES [j NO FZ
VARIANUhi �U��"
I REMARKS I
[] YES
PERMIT NUMBER
TYPE OF CONSTRUCTION STREET IMPROVED
I [] YES [3 NO
[I NO
BUILDING
VALUATION
WORK TO BE DONE I
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BUILDING PERMIT
2
FEE
PLUMBING
PERMIT FEE
3
Z
4
HEAT & GAS LINE
PERMIT FEB
El NEW
1 El SIGN
NUMBER Or STORIES
SIGN PERMIT
Q Q ADD DEMOLISH
0 PENCE
5
FEE
DEMOLITION
to
0
ALTER
MIN: RESIDENTIAL
NUM13ER OF
s
PERMIT FEE
DWELLING
7
PLAN CHECK
REPAIR
NON-RESIDENTIAL
UNITS
FEE
IFR-OPOSED USE
DUE
8
AMOUNT
I hereby "knowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation 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-
THIS PERMIT
This application is not a permit until
lating coastraction; and In doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
Will be employed In violation Of the Labor Code of the State of Washington
ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workmetell Compensation Imurmnce-
WORK NOTED
receipt is aelmowledged In space provided.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
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INSPECTION
SIGNATURE (OWNER OR AGENT) DAT4 muNED
DEPARTMENT
2 - 7
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CITY OF
EDMONDS
DATE
NOTE: Applicant Siibjcct to Plan Check Fee
PR 0-1107
This perralt cov� work to he done on private property ONLY.
Any construction on tile public domain (curbs, sidewalks, driveways,
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marquees, etc.) will rtLquire. separate pernilmalon.
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