660255.pdf..:
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DEPARTMENT
APPLICATION
Applicant Fin
Inside Heavy Lines
TZLEPHOIN
C: D of a,va's
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TELEPHOS
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4A&rtL
We' tF N•F
TELEPHOI
IE'M'd-
CITr Lloa
So
on of
Property (Show
Below
or Attach F
VC)/,
'of�
2
u.
NEW
p
U SIGN
ii
�.
ADD
DEMOLISH
FENCE
Iq
ti
ALTER
RESIDENTIAL
OF
I
(NUMBER
DWELLING
L
REPAIR
NON-RESIDENTIAL
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's Compensation Insurance,
(Except Demolitions which shall
NOTE: Permit Limit Onelear be completed In ninety days.)
TE: Applt nt Subject to Plan Check Fee
This Permit mvero
work to
be done
on private property ONLY.
Any construction on
the public
domain
(curbs, sidewalks, driveways,
marquees,
etc.) will
require
separate permission.
; 0. r/
RD SETBACK(
qE
RUE
BUILDING
I VALUATION
■ :•L1 I
a"N
1f3i�a
SIGN PERMIT
li FEE
DEMOLITION
8 PERMIT FEE
7
PLAN CHECK
81 AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
dd
.il
x
PERMIT 660255
NUMBER
2
1
z
0
;,77
1/0.m0_1
APPLICATION APPROVAL
This application Is not a permit until
signed by the Director of Building Inspeew
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
FILE
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