650367.pdfBUILDING DEPARTMENT Applicant FM
I PERMIT APPLICATION I inside Heavy Lines
Q V" \i // 6 C) 0 H o t\ktr KX,
Lo
TZ EPHONE NUMBER
12 k )
-7 C/
"Ch" 'S ol
11 TELEPHONE NUMBER
rq
VC
1APDRESS
CITY WEL'il;P1.101NE; INUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
I
PERMIT
NUMBER 650367
)RESS — Ye; 1�
— / 7 3 H:6-
D I SETBACK STREET_!ETBAUA
:::?J� —7-L—
VACANT SITE
)NE
LOT AREX [3 YES [3 NO
kRK8
al Description of Property (Show Below or Attach Four copies)
P—ERCTEST PERMIT'
C_ QJ,- C_ D
FIRE ZONE TYPE OF CONSTRUCTION TREET IMPROVJ
> )k_�_VT AN cz� H CC 0 YES [3 No
NEW
SIGN
ADD I
DEMOLISH
FENCE
IQ
0
1:1
ALTER
RESIDENTIAL
NU or
REPAIR
NON-RESIDENTIAL
V=ER
D LING
UNITS
F�
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-
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 Workmen's Compensation Insurance.
ept Demolitions which shall
NOTE: Permit Limit One Year /1's'e)'completed In ninety days.)
;1
�R OR AGENT) DATE SIGNED
NOTE: Applicant Sitbicct to Plan Chcck Fcc
-Tid, —Perndt covers work to be done on private Property ONLY -
Any construction On the public domain (curb#, aldewalks, drivewaYs,
marquees, etc.) will require separate permission.
[] YES
BUILDING
1
VALUATION
Z
0
2
BUILDING PERMIT
FEE
77
PLUMBING
00
3
PERMIT FEE
I
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
81
AMOUNT DUE
rT.,7 �._7
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
INSPECTION DIREc r
DEPARTMENT
CITY OF
DAT
EDMONDS
Pit 6-1107
FILE