660491.pdfBUILDING DEPARTMENT
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PERMIT APPLICATION Inal I do Heavy Lines
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ADDRESS
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CITY TELEPHONE NUMBER
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WORK TO BE PONE
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KROLL MAP NO.:
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4 1 1 ,
PERMIT
NUMBER
I — / Q 0
':173 A/' 10 YES 13 NO
NUMBER
HEIGHT BUILDING AREA VARIANCE
I PLOT PLAN APPROVED
NEW
1:1
SIGN
NUMBER OF STORIES
I
ADD
DEMOLISH
FENCE
ALTER
F] RFSIDENT IAL
N OF
REPAIR
NON-RESIDENTIAL
D=ER
I UNITS
I hereby acknowledge that I have read thin application; that the In.
formation given Is correct; and that I am the owner, or the duly author-
Izod 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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
3IGNATURE (0 DATE SIGNED
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N071VAPPlicant Subject to Plan Check Fee
This Permit covervi work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, drivewayn,
marquees. etc.) will require separate pexmisslon.
I
0 YES
PLAN
[] NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
-EDMONDS
PR 0-1107
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[] YES [J NO
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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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