650370.pdf11) ING DEPARTMENT
ERMIT APPLICATION
10C
KAMM
ADDRESS
Applicant Fill
Inside Heavy Lines
— I/
,L MAP NO BUILDING
PERMIT
/ NUMBER 650370
REET SETPACK
REAP. YA11O Sp;TBACK
)T AREA
VACANT SITE
I 0-1-Z's- C3 NO 0
JILDING AREA
I VARIA NUMBER 1�
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II&MAMW
METER SIZE SERVICE SIZE
CLEARANCE BY
I
ICHECKED
pl
REMARKS
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIr NUUM
FIRE ZONE I TYPE OF CONSTRPCTION 'I STREET IMPROVED
SIGN
NUMBER F STORIES
NEWD I
I El
6�
16iVIE
DEMPLISH
FENCE
0
F-1
ALTER
Ual- RESIDENTIAL
M IER OF
NUWE'
F�
REPAIR
M NON-RESIDENTIAL
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NG
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UNITS
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.
IE,,,pt Demolitions which shall
NOTE: Permit Limit One Your be completed In ninety days.)
SIGNAT RE (OvvNER OR AGE DATE SIGNED
6 - 2
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Any eenstruction on the public domain (curbs, sidewalks, drIvewnym,
marquees, etc.) will require separate permission.
_3� I __Z�Z 1 13 YES 0 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
13 YES 2P116-
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
ME
DEMOLITION
a
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
0
APPLICATION APPROVAL
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 aclmowledged in space provided.
FILE
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