660526.pdfP
I
f
{I•'
(r.
I.
.
f
i
I
e
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
Mabel Blake Smith
M/1ILINO ADDRESS
18922 Olympic View Dr.
en.,.=
IIIIIIIII! [am
Water Heater Exchange
11447 - 120th Ave. N.E.
Kirkland L IVA2 - 6089
C
13 NC
BUILDING
WORK TO BE DONE 1. VALUATION
BUILDING PERM
2 FEE
PLUMBING
3 PERMIT FEE
O
HEAT d: GAS LU
4 PERMIT FEE
NUMBER OF STORIES
NEW SIGN SIGN PERMIT
b FEE
q ❑ ADD DEMOLISH I. FENCE
I DEMOLITION
n ALTER + RESIDENTIAL I NUMBER OF d PERMIT FEE
DWELLING p� �E�
REPAIR NON-RESIDENTIAL UNITS 7 gyp)
PROPOSED USffi
s AMOUNT D
I hereby acknowledge that I have read this application; that the in- ATTENTION
formation given is correct; and that I am the owner, or the duly author-.
,zed agent of the owner. I agree to comply with city and state laws regu- THUS PERMIT
IaUng construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance, WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days,)
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
j, DEPARTMENT
J 1 "f CITY OF
EDMONDS
NOTE: APPlic SUN t to Plan Check Fee PR 6-1107
This Permit, coven work to be done on private propeKy ONLY,
Any construction no the public domain (curbs, sidewalks, dril'eways,
marquees, etc.) will require separate permission,
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 aclmowledged in space provided*
f