660379.pdf—
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BUILDING DEPARTMENT
PERMIT APPLICATION
r ° NAME (OR NAME OF SUBDOi88)
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MKILING D
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NAME
E7 ADDRESS
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CITY. TRION
i` NAME AA''
In ADDRESS
CITY ' CITY {'ELEM
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I STATE LICENSE NUMBER CITY L
is
Legal (Description of Property (Show Below for {!AIM
t C
W
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NEW O I SIGN NUMBER OWSTOIUES
ADD DEMOLIanIR
FENCE
ALTER I RESIDENTIAL I NUMBEG
R OF
DWELLIN
REPAIR NON-RESIDENTIAL UNITS
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-
ised agent of the owner. I agree to comply with city and state lawn regu-
lating construction; sod in doing the work authorized thereby, no person
will he employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One ear be"c mpl�e In Demolitions whichtdays.)
shall
AGNATURE (OWNS- AGENT DATE SIGNED
NOTE: ApplJcdnt Subject to Mn Cbeck Pee
This Permit covers
work to
be done
on private proporly ONLY.
Any construction m
We public
domain
(eurbe, sidewalks, driveways,
marquees,
etc.) will
rr td"
separate permisslon.
I. -winvablig
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED11iOND$
PH d-1107
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APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inepec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in apace provided.
DIRECTORS 13IGNATUREeor 1
J
DATE /
M