660226.pdfZ
BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
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F.A.
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or
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El
I Li SIGN
ADD
DEMOLISH
I [:] FENCE
ALTER
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M RESIDENTIAL
NUMBER OF
I
F�
REPAIR
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[_� NON-RESIDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to 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 regu.
lating 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'5 Compensation Insurance.
11x,,p1 Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
jIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Snbject to Plat: Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
0 YES
LOLL MAP NO.: BUILDING
PERMIT
NUMBER 660226
-.2 / '7 C? 2z-
0 NO
BUILDING
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
FEB
8
AMOUNT DUE
ATTENTION
THIS PERIII[IT
AUTHOIUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMONDS
PR 0-1107
YES E] NO
,RIANCE NUMBER
Z
Q
ffECKED BY
BER
STRE, T IMPROVED
0 YES 13 NO
IROUP
TOTAL FEE
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.
FILE
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