660340.pdfBUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
NAME.(OR NAME F BUSINESS
IaAn4fo ADDRESd
vex,
�.,�MPRIINM WTTMRPH1
99 KD-DRESS/
4C, —Y —1—T—DUPHONE - NUMBER
or
909-
IPERMIT
NUMBER
6603410
[] YES [3 NO
0 YES 0 NO
[3 YES [j NO
PLAN CHECKE Y
VALUATiON
�TTOTAL �FIZX
BUILDING
1
VALUATION
Z
WORK TO BE DONE
ZS_
Z
2
BUILDING PERMIT
FEE
"a
3
PLUMBING
PERMIT FEE
w_�14,2
ZA
4
HEAT & GAS LINE
PERMIT FEE
io e'7
NEW
ADD
E] SIG
11 SH 1
I DEMOLI El FENCE
NUMBER OF STIO
5
SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
ALTER
REPAIR
0 RESIDENTIAL
NON-RESIDENTIAL
N MBER OF
DUWELLING
I UNITS
7
PLAN CHECK
FEE
8
AMOUNT DUE
0 a
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 -gith 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 Umit One Year be completed in ninety days.)
sioNTI—J-URE �(ONVNER OR AGENT —)DATE SIGNED
AT=NT]ION
TIUS PEn5nT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
APPLICATION APPROVAL
This application is not a permit until
S Igned by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged In space provided.
R CT07AN;ATURE
NOTE: Applicant Stibiccl to Plan Check Fee
CITY OF
EDMONDS
rn 6.1101
E
teo AC
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewallim, drJVmftYm,
marquees, etc.) will require separate PremissIO".
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