650346.pdf0
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BUILDING
DEPAR—TMENT Applicant Fill
PERMIT
I
650346
NUMBER
PERMIT APPLI Inslde Heavy Lin s
CATION
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
Z5_0 -7- A< Z
0 0
SIDE YARD SETBACK STREET SETBACK
ROAR YARD SETBZ
;Z
A "#? dV1 114:-
M,%TLIN. AD
?SO -7 1 eb L4J
U ZONE LOT AREA
VACANT SITE
-
CITY TELIOL-11UNN 14UMBER
YES [3 NO
C—dr"c alds A; P 13 81 - (0 :�:� 5�
NAME
BUILDING AREA
VARIANCE NUMBER
P19T-PLA" AP ED
7
ADDRESS
REMARKS
CITY TELEPHONE NUAMER
REMARKS
1A
ADDRESS
METER SIZE SERVICO SIZE CLEARANCE
CHECKM BY
CITY TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER CITY LICENSE NUMUER
Legal seer ptlon of PtIpIrty (She Rel or Attach Four Copies)
TYPE CONNECTION VERIFIED
BY
PERO. TEST PER T NUMBER
Z
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVI
1[3 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES [3 NO
BUILDING
IS 0
W7
VALUATION
�To
C_ZLt__�elc
BUILDING PERMIT
FEE:
2
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
@-,,NEW
ADD
DE28H
SIGN
PENCE
NUMBER OF STORIES
5
—
- SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
ALTER
REPAIR
%Zr'& RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
6
7
PLAN CHECK
FEE
PROPOSED USE
1-0 CQ e ca ci C? tv -roc.
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
ized agent of the owner. I agree to comply with city and state laws regu-
TIUS PERMIT
lating 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.)
SIGNATU,4E (GWNEI$ OR TG-ENT) DATE SIGNED
44 Ot� 7.- 6 Z;o
INSPECTION
DEPARTMENT
CITY OF
�OT-
EDMONDS
Applicant Subject to Plan Check Fee
N A��7
PR 6-1107
This Permit covers work to be done onprivate Property ONLY.
Any construction on the public domaln (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I I ---?- 6k-0 I
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; mid fees are paid, and
receipt is aclaiowledged in space provided.
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