650301.pdfk.,
POSTED ON KROLL MAP NO.: BUILDIN
RVILDING DEIARIMENI PERMIT
Applicant Fill NUM13ER
TERMIT APPLICATION Inside Heavy 7Ltnes joB ADDRESS
NAME (OR NAME OF BUSINESS) /s; / 0 '?
SIDE YARD SETBACK STREET SETBACK REAR YARD BET13ACK
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A lv"� I - 1 *2
ZUELNG ADDRESS 7 *7_ ,,-
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LOT AREA CANT SITE
c�as-/(:) C/2 P)., ej TELEPHONE NUMBM NO
'CITY C -_ / YES
HEIGHT 13UILDING AREA VARIANCE NUMBER
Ptz- (0 a q (� I
MAME
PLOT PLAN: P711D ow
(q C_
ADDRESS
r - REM�RXS
CITY TELEPHONE NUMBER
NAM
REMARKS
F/dWAU 0k(qC-_,S:S
Z
ADDRESS
s-./ 6 C13 P11 t1d Lt pf/y/o 14 0j, METER SIZE SERVICE SIZE CLEARANCE CHECKED By
CITY TELEPHONE NUMBER
I P(Z -ACO D Ci ff / REMARKS
STATE LICENSE NUMBER CITY LICENSE NUMBER 61& ,
0 21 ok . Ca 41) / I TYPE CONNECTION VERIFIE
785—
I -D iption of Propqrty (Show Below V Attach Four Cople
_PERC_. TE PERMIT ER
r -7 - �;r
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
__f No
__JZ 1 [3 YES
W
E]
YES O�No-
PLAN
CHECKED BY
VALUATION
TOTAL FEE
BUILDING
VALUATION
d d.
Z
6
Q
02
WORK TO BE DONE
2
3
BUILDING PERMIT
FEE
PLUMBING
PERMIT FEE
e)
4
5
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
FEE
NEW
ADD
.12113.1
SIGN
PENCE
NUMBER OF STORIES
—
6
DEMOLITION
PERMIT FEE
ALTER
REPAIR
to RESIDENTIAL
El NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
—
71rEE
PLAN CHECK
s
AMOUNT DUE
2Fkrd
I hereby acknowledge that I have read this application: that the In.
formation given to correct; and that I ELM 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
AUTIIOIUZES
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 acknowledged in space provided.
SIGNAT�ME (OWNER OR AGE T) DATE SIGNED
INSPECT10N
DEPARTMENT
CITY OF
EDMONDS
DIRECTOR'S SIGNATURE
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 6-1101
Z1,
Thin Permit Covers work to be done on Private Property ONLY.
Any Construction on the public domain (curbs. sidewalks, driveways,
nutrqueen, etcJ will require neparaite permlmslon.
FILE