660523.pdf"'SUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR MUTE OF BUSINESS)
72
1610 '�z5z
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NEW
o
SIGN
F� ADD
DEMOLI
Ej FENCE
ALTER
RESIDENTIAL
NUM' IER OF
REPAIR
F-1
NON-RESIDENTIAL
DWELLING
I UNITS
I hereby acknowledge that I have read this appileation; that the in-
formation given is correct; and that I alm the owner, or the duly author-
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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
I
NOTE: Applicant Subject to Plan Check, Tee
ThIN IlermIt covers work to be, done oil private property ONLY.
Any construction (In tile public domain (curlim. midewalks. driveways,
martinees, etc.) will require Keparate pernlIN91011.
Q YES
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FIX-,
PLAN CHECK
7
FEE
8
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
I -It 6-1107
NO.: BUILDING
PERMIT
I NUMBER
660523
[] YES
0 YES
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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.
FILE
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