660436.pdfPILDING DEPARTMENT
i,r �!,. , I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
itAME (OR NAME OF BUSINESS)
KATI NG ADDRESS
Rd 6
)ITY TELEVRONE NUMBER
Zsc�
or
[] YES
Elm
BUILDING
VALUATION
WORK TO BE DONE I
BUILDING PERMIT
2
FEE
A:116,;? "9L 6,te�p
PLUMBING
's
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NEW
ADD
El
E MOLISH
0 SIGN
1 E] FENCE
NUMBER OF. STORIES
5
SIGN PERMIT
FEE
1:1
DEMOLITION
PERMIT FEE
ALTER
94 MJW REPAIR
=1
NJ
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
6
7
PLAN CHECK
FEE
PROPOSED USM
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given in correct; and that I am the owner, or the duly author-
ATTENTION
ized agent of the owner. I agree to comply with 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 Workman's Compensation Insurance.
THIS PER311T
AUTHORIZES
ONLY THE
WORK NOTED
(EXCepL Demolitions which shall
NOTE: Permit Limit One Ye U�e completed in ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
%
0A
INSPECTION
DEPARTMENT
CITY OF
EDBIONDS
NOTE: Applicant Stibil
ject to Plan Check Fee
PR 6-1107
This Permit ")van work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewayn,
marquees, etc.) will require Reparate permission.
C,
NO.: BUILDING
PERMIT
NUMBER 660436
[] YES
0 V
[3 NO 0
V95ER I
Ik
[3 YES [3 NO
0
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.
FILE
a