660512.pdfSTED ON KROLL MAP NO.:
PERMIT
BUILDING DEPARTMENT Applicant Fill NUMBER,
inside Heavy TAnes JOB ADDRESS
PERMIT APPLICA1
M 7;9F —wlmm RE, RTIATNICIRAII 09 5?0' C 77 dd
CITY
All
NAME
ADDRXSS
CITY
owim
I
V_
or
!ISMi
U
NEW
Lj SIGN
ADD I
DEQISH
PENCE
ALTER
RESIDENTIAL
ER OF
=ZLING
I
REPAIR
NON-RESIDENTIAL
I UNITS
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-
ized agent of the owner. I agree to comply with city and state lawn regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Coda of the State of Washington
relating to Workmen's Compenfiation Insurance.
IEI,Oepl Demolitions which shall
NOTE Permit J.imit One Year be completed In ninety days.)
660512
CANTT SITE
YES 13
MIANCE NUMBER
061
a
z
N
I
13 YES 13 NO
BUILDING
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
7
FEE
81 AMOUNT DUE
0 YES 13 NO
11TTENT11ON I APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
I receipt is acknowledged In space provided.
OR AGENT) DATE ON INSPECTION
Z7 DEPARTMENT
7 CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
This Perrult covers work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will require separate perrnission.
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