660067.pdfBUILDING DEPARTMENT Applicant M
do Heavy Unes
PERMIT APPLICATION Ing'
NAME (OR NAME OF BUBINH
SO/
-NUaLING ADDREBS
7'H -
f 0 e)AlPs
NAME
U
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or
--3/d- ( (
(3 YES
PERMIT
NUMBER 660067
V
SETBACK I STREET SETBACK I REAR tjUM SETBACK
0
ru =
Ilk
i
[3 YES
11
NO
d I I
BER
[3 NO
16
41
I
BUILDING
VALUATION
Z
WORK TO BE DONE
2
BUILDING PERMIT
rnm
3
PLUMBING
PERMrr FEE
4
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
FEE
1Z
NAEDWD
DEMOLISH
OF STORIES
r-rj=4
—
6
DEMOLITION
PERMIT FEE
El
ALTER
REPAIR
r1cul
LPJ RESIDENTIAL
NO.-..I....L
NUMBER OF
DWELLING
UNITS
7
PLAN CHECK
FEE
11
PROPOSED USE
I
8
AMOUNT DUE
0
I hereby ark owledge 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-
I&Ung 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 shoal
NOTE: Permit Limit One Year be completed In ninety days.)
BIG 4ATURE (OWNER OR AGENT) DATE SIGNED
i;i_— m
Al j"
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
APPLICATION APPROVAL
This application is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is aclmowledged in space provided.
DIRECTOWS SIGNATURE
DATjF;_'
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
FILE
This permit covers work to be done an VrIv9de property ONLY -
Any construction an the public domain (curb$, sidewalks, drivewAYS.
marquees, etc.) will require separate permission.
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