660073.pdfF.7
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POSTED
ON KROLL MAP NO.:
BUILDING
WILDING
DEPARTMENT
I
Applicant F171
PERMIT
NUMBER
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RMIT APPLICAT101 inside Heavy Lines
E3 (OR NAME OF BUSINESS)
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JNG ADDRESS
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TELEPHONE; NUMBER
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TELEPHONE NO ER
LICENSE NUMBER CITY LICENSE NUMBER
)escription of Proper ty (Show Below or Attach Four Copies)
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NEW
[_j SIGN
S�Fr I
ADD
DEIRSR
1 0 FENCE
I
ALTER
RESIDENTIAL
N OF
D=ER
LING
REPAIR
NON-RESIDENTIAL
UNITS /
MOR"
I hereby atknowledd64hat I have read this application; that the In.
formation given is correct; and that I am the owner, or the duly allthw-
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 Workman's Compensation Iasurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
A
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NOTE: Applicant Sitbject to Plait Check Fee
This Ilemit covern work ta be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate perminnion.
]BE ZONE
LOT AREA
VACANT BITE
1 0 YES [3 NO
EIGHT
BUILDING AREA
VARIANCE NUM13ER
UTT -PLAN APPROVED
ZMARKS
XMARKS
IETER SIZE I SERVICE SIZE I CLEARANCE CHECKED BY
LEMARKS
�YPE CONNECTION
VERIFIED BY
IERC. TEST
PERMIT NUMBER
[3 YES
[] NO
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 1 AMOUNT DUE
ATTENTION
THIS PER511T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
I [] YES 0 NO
W-AM
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1 1 .5-. " 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 aclmowledged in space provided.
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