660253.pdf4, 1 f
BUILDING DEPARTMENT Applicant Fill
0
Inside Heavy Lines
PERMIT APPLICATION
7
E R L
NAM (OR NAIM OF BUSINESS)
7,j�,;� z/-2
CITY WE PHONE NUMBM
&bMQA)hS. 1AJASA PP-9-:38,31
NAME
or
/-3
t=,qC_-r012AF .- 30,040-vG'.
NEW SIGN NUMBER OF STORIE
0 SH FENCE
ADD I DEMOLI
R F
ALTER RESIDENTIAL NUMBE 0
DWELL NG
REPAIR NON-RESIDENTIAL I UNITS
PROPOSED USE
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 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 Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
W�SIGKAI
,;Z9jMA_OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Sitbject to Plan Cherk- Fee
Thin Permit covers work to be done on Private Property ONLY.
Arty construction on the public domain (curbs, sidewalks, driveways.
marquees, ric.) %vill mquirr separate permission.
OF
0 YES [j NO
NO.:
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
IN
0 YES [3 NO
Z
2,00
7 ;= Penalty 2900
8 AMOUNT DUE 4,00
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES Igned by the Director of Building InsPec-
ONLY THE S
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acimowledged in space provided.
INSPECTION R TO NATURE
DEPARTMENT
CITY OF
EDIVIONDS PATE 100r, r
PH 0-1107
FILE