660166.pdfPOSTED ON KROLL ly
BUILDING
DEPARTMENT
AppIlleant M
PERMIT
APPLICATION
7Inside 7HeavyLlnes
8 Heavy
JOB "DRESS
NAME (0 NAME OF BUSINESS)
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3
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SIDE YARD sETBACI
0 0,
6
P/T ep — �), �, �
11LEPHOND NUMBER
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FIRE ZONE
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13PECIAL 5
0 YES
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NAEDWD
[—] SIGN
NUM13ER OF STORIES
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DEMOLI SH
0 FENCE
ft
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LtC,, RESIDENTIAL
NUMBER OF
n REPAIR
I
F-1 NON-RESIDENTIAL
DWELLING
I UNITS
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-
Ized agent of the owner. I agree to comply with city and state laws re
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lating construction; and In doing the work authorized thereby. no person
will be employed In violation of the Lobe o the State of ton
a of a
relating to Workman's CompnaT21on' urance.
(Except Demolitions which shall
NOTE: Permit Limit One Y r be completed In ninety days.)
_jj1_GNATURE (OWNER OR AGENT) TE IGNE�
TE: APPlicant Sitbicct to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbo. sidewalk", driveways,
marquees. etc.) will require Reparatr PermIRRIM.
0
[] NO
BUILDING
1 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 AMOUNT DUE
ATTENTION
THIS PE1011T
AUTHORIZES
ONLY THE
WORIC NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
BUILDING
PERMIT
0 PP0.3 -�Jl /->" 57- _'5 &A�)
[3 YES
[3 NO 0
!WF_R I
0 YES [:) No
1 1 .2— 49—t) 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 acknowledged in space provided.
FILE
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