660181.pdfI §
D,ING DEPARTMENT Applicant ]Fill
MIT APPLICATION Inside Heavy Lines
(O—WNAME OF BUSINESS)
1, AMDRESS
7
TELEPHONE NUMBEFt
71
ow isciow or
NO.:
PERMIT
NUMBER 660181
USE ZONE LOT AREA =VAC7 SITE
0 No
E94ES [3 NO
I ),F-) - 0 1 1
\1
T1_
SPECIAL INSPECTOR nZWul"U
[j YES 0_09�0
BUILDING
VALUATION
WORK TO BE DONE
I
BUILDING PERMIT
FEE
2
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
A
0
SIGN PERMIT
FEE
NEW
ADD
El SIGN
I DEMOLISH El FENCE
NUMBER OF ST01RUIES
-2 5
—
El
DEMOLITION
PERMIT FEE
ALTER
ElREPAIR
1U1
jaj RESIDENTIAL
NON-RESIDENTIAL
6
MBER or
—
NU L
DWEL ING
UNITS 7
PLAN CHECK
FEE
a
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author.
ATTENTION
Ized agent of the owner. I allee to comply with city and state laws rmvgu-
THIS PERMIT
lating construction; and in doing the work authorized thereby, no person
AUTHOIUZES
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
relating to Workman's Compensation Insurance.
WORK 240TED
(Except Demolitions whIch shall
NOTE: Permit Limit One Year be completed In ninety, days.)
SIGNATURE (OWNER OR AGENT) M�,
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
1-n 6-1107
This remit covers work to be done on private Property ONLY.
Any construction on the public domain (carbs, sidewalks, drlvmvnyn,
marquees, etc.) will require. separate permission.
0 YES 0 No
/9
0
6
Z
W
I I �-_,�q 0 1.
APPLICATION APPROVAL
This application is not a perndt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclanowledged in space provided.
Tjjjg��SIONANURE
DATE- 41
UM
A
o I
I
All, .1
Ij
I