660422.pdfI OSTEE
BUILDING
DEPARTMENT
Applicant FIR
PERMIT
APPLICATION
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BUILDING
VALUATION
WORK TO BE DONE
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BUILDING PE7RUIMUT
FEE
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PLUMBING
CA-1Z
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
SIGN
NUMBER OF STORIES
NEW
5
FEE
14
ADD
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DEIPISH
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DEMOLITION
PERMIT FEE
04
0
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El ALTER
RESIDENTIAL
NUMBER OF
6
PLAN CHECK
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DWELLING
I UNITS 7
REPAIR
NON-RESIDENTIAL
FEE
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
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-
THIS PERMIT
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
will be employed in violation of the Labor Coda of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
SIGNTTURE —(OWNER OR AGENT) L)A'I:rj ellu"ND
INSPECTION
DEPARTMENT
(a A
CITY OF
EDMONDS
NOTE: AW-C it Subject to Plan Cbeck Fce
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the Public domain (curb%, sidewalks, driveways,
marquees, etc.) will require separate permission.
NO.: BUILDING
PERMIT
NUMBER 660422
YES [3 NO 0
LRIANCE NUMBER
I D YES 0 NO
OCCUPANCY GROUP
VALUATION TOTAL FEE
55
400
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.
D
DATE —
FILE
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