660245.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (Oft NAMJQ UF JJU"I
NICUS
TE PHONE NUMBER
NAME
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or Attacn.
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PERMIT
NUMBER 61
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57 7
3 SETBACK STREET SETBACK WbE TA
LOT AREA VACANT
10 , YES
*0 ZONE
37P
ov 13PECLILL INUPEUffR-
13 YE 8 NO
1
V6 V lk Jr:-_PLWAd f -0 H E C K E D B Y
a P 45r.,- Pin
NEW I L_J SIGN
ADD DEMUOSHI 1:1 FENCE
M
ALTER I /\I RESIDENTIAL ER OF
rW%E aNG
REPAIR NON-RESI D.;ENTIAL I UNITS
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-
ized agent of the owner. I agree to comply with city and state laws rOgul
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's Compensation Insurance.
ll,,,pl Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
31ON
AT (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
BUILDING
I
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: 06
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMONDS
PH 6-1107
n/
45
e ex_o� -
0 YES 0110
6
Z
W
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.
Thin PC Tolt covers work to be done an Private property ONLY. FILE
Any construction on the public domain (curbs, sidewalks, driveways.
manums, etc.) will require separate permission.
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