650420.pdfPOSTED ON KROLL MAP NO.:
BUILDING
BUILDING DMMMENT
PERMIT
660112
Applicant Fill
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOBADDRESS
- I/
NAME (on NAME OF BUSINESS)
SIDE YARD. SETBACK
STREET SET9VACK
HEAR YARD SETBACK
lines
MAILING ADDRES13
U NE
LOT AREA
VACANT SITE
YES [3 NO 0
CITY
TJ9"rUUN19 14UMBER
Z,
HEIGHT
BUILDING AREA
VARIANCE NUMBIGAt
-4-:11
PLOT PLAN A.PMOVW
AW
or
/I
0 YES [3 NO
or
I
1
BUILDING
VALUATION
wol BE DONE
BUILDING PERMIT
2
FEE
3
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NEW
AD D
DEMOLI
SIGN
FENCE
RI
NUMBER Or STO E13
0
5
SIGN PERMIT
FEE
6
DEMOLITION
PERMIT FEE
-
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
N UX EaR 0 F
D ja No
UNITS
71
PLAN CHECK
FEE
PROPOSED USE
8
AMOUNT DUE
I hereby acknowledge that I have read thla application; that the in-
Al
y no
formation given Is correct; and that I am the owner, or the duly author-
o motion given is
f rL
ATTENTION
Ized agent of the owner. I agree to comply with city and state laws regu-
Iz t I h
agen 1 0 0'
THIS PE11511T
,ereb
lating construction; and in doing the work authorized thereby, no pe * roon
Ing co 5 ction.
I:td
will be employed In violation of the Labor Coda of the State of Washington
will be employed In
AUTHORIZES
ONLY THE
relaUng to WorkmWs Compensation Insurance.
WORK NOTED
N T Perm il (Except Demolitions which shall
OTE: Permit Limit 8"ar be conipleted in ninety days.)
-SIONATbil,E (OwNEVt OR DATE' SIGNED
—4;2,9 6
aj I
I
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Piln Check Fce
PH 6-1107
This Permit covervi work to be done on private property ONLY.
Any construction an the public domain (curb*, oldewalks, driveways,
marquees, etc.) will require separate permission.
13 YES [3 NO
PC
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.
FILE
I
F1