660307.pdfED ON KROLL MAP NO.:— BUILDING
BUILDING DEPARTMENT PERMIT 660307
Applicant Fill NUMBER
PERMIT APPLICATION
Inside Heavy LItnesJOB
ADDRESS
NAME (OR NAME OF BUSINESS)
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-A
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-BIDE YARD BET13ACK
STREET sETITACK
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MKILING ADDRESS
PL S> t0
US
LOT AIFE—t.
CITY-
TELEPHONJS LMUMBXR
DE- -f AD LTrD
ADDRESS
17% a UWAG F—
or
ram
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BIG,
138
NUMBER OF STORIES
El
MOLISH
E]
ADD
rll
FENCE
ALTER
RESIDENTIAL
R 0
=E F
F� REPAIR
F-1 NON-RESIDENTIAL
I UNITS NG
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 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.
NOTE: Permit Limit One Year 'E""'dt? ions which shall
be c_pj jc�inio ninety days.)
_P
E:
to Plan Chenk Fee
—ilds _PC=It covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
9
[] YES
[] 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
7
FBI,
8
AMOUNT DUE
ATTE ION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I
7 j
VACANT E
[3 YES
[3 YES [3 NO
Z
r=1
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.
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