660428.pdfk
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BUILDING DEPARTMENT Applicant Fin
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
e , /9, b�j &, S 6 Aj.
MAIL-ING ADDRESS
CITY I T-ELEPHONE NUMBXR
rz j I.., I 1��,q -. M 47a.
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I N NEW El Lj SIGN ......
SH I
ADD DEMOLI 1:3 FENCE 7)
ALTER RESIDENTIAL NUMBYLIR�
DWELLING
REPAIR NON-RESIDENTIAL UNITS
-TH-MO-SR-Duan I
P CA.)
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 auth�
]zed agent of the owner. I agree to comply with city and state laws regu.
lating eoustrucUon; 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year 11111PI Demolitions which shall
be completed in ninety days.)
1IGNATURE (OWN R OR AGENT) TE SIGNED
0/ jr 11, TV04
oiii� 2e iLfl�
NOTE: Applicant Subject to Plan Check Fee
This Perralt coven work to be done on private property ONLY.
Any construction on the public domain (curbsp sidewallEm, driveways,
nmrquees, etc.) will require neparate pernilasion.
PERMIT
NUMBER 660428
t/ � fe/ //; ) 11
WA
USE ZONE LOT AREA VACANT SITE
M-TES C3 NO
HI-31GHT BUILDING AREA VARIANCE NUMBER
PLOT PL.AV,�PPIJ6VED I Ik
..........
'-'77_:,:,�1
METEI) SIZE
I SERVICE SIZE
CLEARANCE
C HlAqe BY
_5A �t
I ycl I(
I
I
REMARKS
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TYPE CONNECTION
1
VERIFIE
PERC. TJVT
PERMIT VJt:ER
FIRE ZONE
TYPE OF CONSTRUCTION
STREET IMP70VED
1
1 [3 YES a-60C`
I
[] YES
I I VALUATION
BUILDING PERIUT
2
FEE
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
FIN 1 0 �ib J�
ATTENTION
THIS PETURT
AUTHOIUZES
ONLY TIEE
WOIiK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 0-1107
PRE
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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