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6 DEPARTMENT Applicant FBI
Inside Heavy Lines
WM.APPLICATION
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A,9NAA
D ON KROLL MAP NO.: BUILDING
D PERMIT
NUMBER
)DRESS
Y0AR&itBACK5J'?8TREET BET13ACK REAR YARD SETBACK
USE ZONE
VA `NT SITE
LOT AREA CANT SITE
�S��"�,EPHONE N MBER
YES NO 0
9 Z�51
HEIGHT
BUILDING AREA VARIANWE XV4M�ER
I
I
7FLOT —PLAN APPROVED
ow
REMARKS
I TELEPHONE NUMBER
REMARKS
14
JO—DRESS
A
14
METER SIZ
CKED BY
CITY TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMB
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four es)
P RC. TEST
PERMIT NUMBER
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ZONE TYPE OF CONSTRUCTION STREET IMPROV ED
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0 YES [3 No
-Fp—ECLALL INSPECTOR REQUIRED OCCUPANCY GROUP
n YES NO
PLAN CHECKED By
VALUATION TOTAL FEZ
BUI ING
WORK TO HE
I VALUATION
BUILDING PERMIT
Z FEE
PLUMBING
to
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
U
"UMBER OF STORIE9
NEW SIGN
SIGN PERMIT
5 FEE
DEMOLI FENCE
—
ADD
DEMOLITION
0
ALTER NUMBER OF
RESIDENTIAL
PERMIT FEE
DWELLING
PLAN CHECK
REPAIR NON-RESIDENTIAL UNITS
FEE
PROPOSED USE
8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given to correct; and that I am the owner, or the duly author.
lzed agent of the owner. I agree to comply with city and state laws regu.
THIS PERMIT
This application is not a permit until
lattal; construction; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed III violation of the Labor Code of the State of WomhIngton
ONI,Y THE
tion, or his deputy; and fees are paid, and
relating to Workmen'n Compensation Insurance.
WORK NOTED
receipt is acknowledged in space provided.
(Except Demolitions which shall
NOTE: Permit Umit One Year be com in ninety days.)
. - Pkqd
SIGN TER OR AG DATE SIGNED
INSP ECTION
D on's TURE
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chech Fee
J
PU 0.1107
This rermit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
maxqu"s, etc.) will nequire separate Permlamlon.
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RECORD OF INSPECTIONS f.d
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Foundation
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(Rough)
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Furnace & Fuel Unes:/,
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