660234.pdf3D ON KROLL MAP NO.:
DEPARTMENT Applicant F111
PPLICATIONInslile, Heavy Lines] JOB ADDRESS
OF BUSINESS) ( / 1 IC7 4FI6,
9VI 19�
W.
or
14
- � -.1 -
PERMIT 660234
NUMBER
T1_
[] YES 13 NO 0
VA—RUNCM NUM33ER I I
, " YES NO
Q
_SPEC;LAL INSPECTOR REQUIRED OCCUPANCY our
YES 0 NO
PLAN CHECKED BY
VALUATION TOTAL FRIE
WORK TO BE DONE
BUILDING
1 VALUATION
�Z
040"e "V(:: E
BUILDING PERhnT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
NUMBER OF STORIES
NEW SIGN
SIGN PERMIT
A
ADD DEMOLISH FENCE
5 FEE
—
DEMOLITION
ALTER RESIDENTIAL NUMBER OF
6 PERMIT FEE
DWELLING
REPAIR NON-RESIDENTIAL UNITS
f
7
PROPOSED USE
;CA /0-
8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the III -
ATTENTION
APPLICATION APPROVAL
formation given Is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
This application Is not a permit until
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workman's Compensation Insurance.
a
WORK NOTED
11,,,pt Demolitions which shall
Permit Limit One Year
receipt Is acknowledged in space provided.
OTE: be completed In ninety days.)
N ol
SIGNATURE (OWNER R ENT) DATE BIG ED
0 N
INSPECTION
TOR'S 8; �AT;�
4 G.
DEPARTMENT
CITY OF
le
EDMONDS
NOTE: Applicant lan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs. sidewalks, drlvmvayx,
FILE
njorquees, etc.) %vlll require separate permission.
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