660299.pdf.t'
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
NAME (OR NAM OF BUSINESS)
MAILING ADDRESS
CITY
TELEPHONE 14UMBER
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NAME
00*IYSON
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CITT
TELEPHONE NUMBER
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TELEPHONE NUMBER
PR
CITY LICENSE NUMBER
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TYPE CONNECTION
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PERC. TEST
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SIGN
NUMBER F STORIES
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12
ADD
DEMOLISH
PENCE
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ALTER
RESIDENTL&L
NUMBER OF
REPAIRI
NON-RESIDENTIALI
DWnW.aNG
UNITS
I hereby acknowledge that I have read this application: that the In.
formation given Is correct: and that I arn 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 Workmens Compensation insurance.
NOTE: Permit Limit One Year lExeept Demolitions which shall
be completed in ninety days.)
IIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check- Fee
This Permit covers %vork to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, drivenva".
marquees, etc.) will require separate permission.
[] YES a-x(r
I 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 A
'�i
ATTENTION
TIUS PERMIT
AUTlIOR[ZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
PERMIT
V�/ NUMBER 660299
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BUILDING AREA VARIANCE NUMBER
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APPLICATION APPROVAL
This application is not a pern-dt until
igned by the Director of Building Inspec-
ion, or his deputy; and fees are paid, and
ecelpt is acknowledged In space provided.
FILE
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