660537.pdfi
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Linea
)N KROLL MAP NO.: BUILDINI
tot/
, % I NUMBER
/ vnmER (�� NUMBER
Moot
/ //00� �Z!5;
srmI !•�
I( 1 3/a-i(
WORK TO BE DOBUILDING
lop r /1/ I VALUATION
BUILDING PERMIT
Z FEE
PLUMBING
3 PERMIT FEE
HEAT a: GAS LINE
NUMBER OF STORIES ! PERMIT FEE
NEW SIGN SIGN PERMIT
d FEE
C1 ADD DEMO SH O FENCE
E DEMOLITION
ti ALTER I Ll RESIDENTIAL I NUMBER OF S PERMIT FEE
DWELLING PLAN CHECK
REPAIR NON-RESIDENTIAL UNITS 7 FEE
PROPggED USE ^ 8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author. ATTENTION
feed agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
looting construction; and In doing the work authorised thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
retailing to Workmen's Compensation Insurance, WORK NOTED
NOTE: Permit Limit One Year lEzcept Demolitions which shall
be completed In ninety days.)
II�TURE/ (OWN . AGENT) D7,el
SIGN 'D INSPECTION
�� DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Check Fee EDMONDS
PR d-1107
This Permit covers work to be done on private property ONLY.
Any construction or1 the public domain (turbo, eldewalks, drlrew•aye,
marquees, etc.) will require separate permission.
�;
ti to
APPLICATION APPROVAL
is
This application is not a permit until i
signed by the Director of Building Inspec
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided w'
DIIRRECCTTOR'S NATU �o
DATE P.
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