660514.pdfKROLL MAP NO.: BUILDI
PERMIT 6005) 14
DEPARTMENT Applicant FIR NUMBER
APPLICATIONInsIde Reavy Lines JOB ADDRESS 1441c, C4_-.11
OF B�SI�ESB) RD SETBACK
-)R,)6
CITY
,NAME
Q
U
Li
NEW
I
SIGN
I DEMOLISH
FENCE
ADD
ALTER
RESIDENTIAL
NUMBER OF
F-1
REPAIR
NON-RESIDENTIALI
IN
DWELLI G
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to correct: and that I am the owner, or the duly author-
ized agent of the owner, I agree to comply with city and state laws mgU-
lating construction; and in doing the work authorized thereby, no person
will bn employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Umit One Year be completed In ninety days.)
7AT�N R OR DATE SIGNE
4, �(OWZ�
zlp� J��, wj� 7L/O
NOTE: Applicant Stibiect to Plan Cbech Fee
—jid, permit �eevm eork t,, be den, on private projwrty ONIX.
Any ron%truction on tile public demain feurbs, hidewalks, drIvewuys.
marquees, etc.) %vill require Nellitrate IRT11111191(in-
I/X-/
0 YES
A=
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 6-1107
tEA VACANT SITE
0 YES 0 NO
ENG AREA VARIANCE NU �ER
ow
—An
CLEARANCE
VERIFIED BY
PERMIT NUMBER M1
[3 YES Ej NO
0 ID
I I. !ro I
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.
I
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