660122.pdfI Aj n
CITY
IDE
;249
5�
At 15i,
WISUEPHONE NUMBER
�V 07r AIE
A Z: AW
0 fe-e74 3tl Tz z.,, 7 A/
I
/ 4
�Vz AFC
NEW
El SIGN
NUMBER OF STORIES
IUEB
d'e
ADD
1
DEMOLI
I 13 FENCE
pas
ALTER
RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS 2
I her6by acknowledge that I have read this application; that the in.
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 Iowa regu-
luting 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.
11,c,lt Demolitions which shall
NOTE: Permit Limit One Year he completed in ninety days.)
YkNATURE (ONVPPR OR AGENT) DATESIGNED
NOTE: Applicant Subject to Plan Check Fee
This PermJt coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I q I 0-1gi
BUILDING AREA. VARIAN
PHU
__Z�
_T�, W Xj�.. , h
�PE.CONNECTION VERIFIETITI
or
0 YES
11 VALUATION
BUILDING PERMIT
2
FEB
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
81 P MIT
5
rE
DEM TION
6
PER I FEE
P N C ECK
7
FE
8 1 AMOUNT DUE
AT=NTION
THIS PERMIT
AUTHORJ1ZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
I -It 6-1107
SETBACK
No
rUMBER
ja
0 YES 0 NO
I
S-10-
—1 1 6,;Z 00
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 aelmowledged in space provided.
I %r —
FILE
Z
I
0