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X �S,UILDING DEPARTMENT
Applicant Fill
RAPPLICATION Inside Heavy Lines
MIT
(OR NAME OF BUSINESS)
POSTED ON KROLL MAP NO.*.
PERMIT L
NUMBER
a Q 5 r.
;7-.
1 1 [3 YES 13 NO
HEIGHT --A VARIANCE NUMBER
BUILDING ARE
PLOT PLAN APPROVED 1k
10'
Ltd NEW I
0
Li SIGN
2
Q
ADD I
DEMOLISH
PENCE
0
ft
El
ALTER
RESIDENTIAL
0
N =ER F
REPAIR
NON-RESIDENTIAL
LLI
D NG
UNITO I
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I sm. 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 One Year be completed In ninety days.)
8107)L URE (OWNER,011 ENT) DATE SIGNED
t37
. yg�
NOTE. At JiCant Subject to Plan Check Fee
-This rerralt covers work to be done on private Property ONLY.
Any construction an the public domain (curbs. sideivalks, drivetrays,
nuLrquees, etc.) will require separate permission.
0 YES [3 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 FEE
8 AMOUNT DU
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
In
[:] YEB 13 ITO
31
APPLICATION APPROVAL
This application Is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
DIREr,7`911.8 SIGN VqE
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FILE:
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