660540.pdfPOSTED ON KROLL MAP NO.: BUILDING
PERMIT
BUILDING DEPARTMENT ApplIcant NUMBER 660540
PERMIT APPLICATION Inside Heavy JOB ADDRESS _+9-
NAME (OR NAME OF BUSINESS) I q-Z � - / 177 - rP, 9,
0 YES
-7.2, 30
CITY TELEPHONE NUMBER
or
0 "0
r UMB
=
Z
STREET
FIRE ZONE TYPE OF CONSTRUCTION IMPROV!
I [] YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
BUILDING
VALUATION
WORK TO BE DONE 1
BUILDING PERMIT
FEE
2
3
PLUMBING
PERMIT FEE
HEAT & GAS LINE
gl
4
PERMIT FEE
NEW
ADD
D MOLI
E sn
S ION
'ENCE
0 r
NUMBER OF STORIES
5
—
SIGN PERMIT
FEE:
DEMOLITION
PERMIT FEE
ALTER
REPAIR
Nr RESIDENTIAL
NON-RESIDENTIAL
N=ER OF 6
D LING
UNITS 7
PLAN CHECK
FEE
PROPOSED 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
APPLICATION APPROVAL
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 Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days..)
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
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 aclanowledged In space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
%4'r,
LL;_" - i
NOTE: Applicant Subject to Plan Check Fcc
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
PR 0-1107
DIR�: TC(Irt's-BIGNA
"A
DATE
FILE
Thim Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewaym,
marquees, etc.) will require separate permimalon.
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