660104.pdfBUILDING DEPARTMENT I Applicant M
PERMIT APPLICATION Inside Heavy Lines
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13 YES 9-mr-
U'DVAJ I y BUILDING
WOETO BE: DID U 6LL VALUATION
Vi BUILDING PERMIT
FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
R71 NUMBER OF STORIES
L& NEW SIGN SIGN PERMIT
LADI) DEMOLISH FENCE 5 FEE
I I DEMOLITION
ALTER RESIDENTIAL NUMBER OF 6 PERMIT FEE
EZL DWELLING PLAN CHECK
REPAIR 0 NON-RESIDENTIAL UNITS 7 FEE
8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given in correct: and that I am the owner, or the duly author- ATTENTION
Ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
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
hIGH6,ferini it One Yelly be completed In ninety days.)
t*M
R AGFPT) DATE SIGNED INSPECTION
DEPARTMENT
A CITY OF
N EDIVIONDS
NOTE: �Pp+ant Subject to Plait Check Fee PR 6-1107
39
This Permit cover -IFork to be done an private property ONLY.
Any censtruction on the public domain (curbs, sidewalks, driveways,
nuuqueest etcJ will reQuire separate permission,
9
PERMIT
NUMBER 660104
I
0 YES C3 NO
0 YES 0 No
157
APPLICATION APPROVAL
I
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 acknowledged in space provided.
DATE'�'
FILE
. 44-7
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