650374.pdfI � :, 7"
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DN KI
U ILDING DEPARTMENT Applicant Fill
Inside Heavy Line
JOB ADDRESS
FPERMIT APPLICATION
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�Legal I
:)I I I- L-_:
Li El [_j SIGN I �� -"�-
1ZADD FENCE
NEW I DEMOLI
F] ALTER RESIDENTIAL 'UM ROF
I DWELI;TNG
ElREPAIR I El NON-RESIDENTIAL UNITS
PROP,Fsp USE
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 Slats of Washington
relating to Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except Demolitions which shall
be completed In ninety days.)
1IGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Sitbicct to Plan Check Fee
This Fermit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require. separate Permlanlon.
Z-1 fyll� (,/ _.. � I
IDE YARD SETB,�
USE ZONE:
LEIGHT
'LGT�PLAV)APP I RC
F1 . RE ZONE I I..TYPE OF
SPECIAL INSPECTOR R
[3 YES [3 NO
BUILDING
VALUATION
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE,
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
1 AMOUNT DUE
AT=NTION
THIS PERMIT
AUTHOIUZE8
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
PERMIT
NUMBER 650374
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yr A1:LUA VACANT SITE
1 0 YES 0 NO
JILDING AREA VARIANCE NUMBER
ts
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N
[] YES Ej No
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to
APPLICATION APPROVAL
This application is not a pernlit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
DIREC BI A r_%RE oor",Z
ne :�7
DAT
FILE
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