660094.pdfI
or
PERMIT
NUMBER 660094
PISS
D SETBACK SMEET SETBACK REAlt YAJMJ OZ BA,
1 :7—, r 14z:: .
LOT AREA VACANT SITE
YES NO
[] YES [3 NO
BUILDING
VALUATION
RK DO?
/e,
BUILDING PERMIT
FEE
PLUMBING
10
,V / 7
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
02
NEW
ADD I
DEMOLISH
SIGN
FENCE
PRIES
5
SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
ALTER
E] REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELL NG
UNITS 7
PLAN CHECK
FEE
8
FAMO:;; 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
ized agent at the owner. I agree to comply with city and state laws regtl-
THIS PERbUT
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed In violation Of the Labor Code of the State of Washington
ONLY THE
relatIng to Workmen's Compensation Insurance.
WORK NOTED
(Except Demolitions which shall
NOTE: Permit Umit One Year be completed in ninety days.)
E OR AGENT) TE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1101
This Permit CIV,,,, work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, drivewa3ro,
macquees, etc.) will require separate Pernliftsim-
0 YES [3 NO
APPLICATION APPROVAL
This application is not a permit until I
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acimowledged in space provided.
FILE
I . A