660474.pdfI
BUILDING DEPARTMENT Appilemi; FM
PERMIT APPLICATION Inside Iffeavy Lk
CENSE NUMB
or
RIE TO BE D
Lj
NEW
El
I Li SIGN
I
19
ADD
DEMOLISH
1
13
PENCE
ElALTER
64�_
RESIDENTLALL
NUMBER OF
I
REPAIR
1 F1
NON-REsrDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that th in-
formation given is correct; and that I am the owner, or the duly alor-
lzed 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 t,.* Washington
relating to Workmen's Compensation Insurance.
(Except Demolitions which ehall
NOTE: Permit Limit One Year be completed in ninety days.)
PERMIT
NUMBER
YES wa_
BUILDING AREA VARIANCE NUMBETF
'LAN ROVED
[3 YES El4c6_�
13 YES M_901�
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
71pEM
81 AMOUNT DUE
ATTENTION I APPLICATION APPROVAL
THIS PERMIT This application is not a pem-At until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
1ATURE (OWNER OR AGENT) DATE SIGNED
I14SPECTION
DIRECTOR'S SIORATURE
DEPARTMENT
CITY OF
DATE ;;�o
EDMONDS
NOTE: Applicant Subject to Plan CheU
6
PR 6-1107
Thim Permit covers work to be done on private property ONLY.
Any construction an the public domain (Curbs, sidewalkep drivewava�
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marquees, etc.) will require, separate Permission.
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