660359.pdf4
BUILDING DEPARTMEN
PERMIT APPLICATION
NAME (ORNAME OF BUSINESS)
David W, Crow
Dayton
CleAA I
Edmonds, Wash,
NAIM
obert-Lgrgensen
VASS
2nd Ave 3
:Edmonds
NAME
—CTT
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STATIC LICEI
Legal Descrip,
Co
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W WORB
ORB
or
hed
Applicant FM
Inside Heavy Lines
Pr B-6116
W I V, WzT*1
Pr B-6116
NEW
SIGN
ADD t�DEQOLISK
JH
ALTER
RESIDENTIAL
NUMBER OF
I
REPAIR
DWELLING
UNITS
r hereby acknowledge that r have read this application; that the In.
formation given In correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city an%j state laws regu.-
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Codj of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year 11xc1P1 Demolitions which shall
he completed In ninety days.)
7/11/66
NOTE: Applicant Subject to Plan Check Fee
Thin ]Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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MAP I LNG
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660359
DR
NC
STREET SETBACK
REAn YARD SETBACK
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LOT AREA
VACANT SN��
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BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERmrr FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
81 AMOUNT DUE
ATIENTION
TIUS PERBUT
AUTHORIZES
ONLY. TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
Ian 6-1107
APPLICATION APPROVAL I f�'
This application is not a perinit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is aclmowledged in space provided.
X-/ - W/ C
FILE
0
ril
77.
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