650450.pdfi
ILDING DEPARTMENT Applicant FM
ERMIT APPLICATION- Inside Heavy Lines
SAME OF BUSINESS)
DRESS
-17JU�PHONE NUMBLR
ct &- Md r / �
NEW 1 0 , , SIGN
ADD DEMOLISH FENCE
0 NUMBER OF
ALTER RESIDENTIAL DWELLING
REPAIR NON-RESIDENTIAL I UNITS
too le, 'S 0
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 the,"aby, no person
will be employed in violation of the Labor Code of the State of WaBbIngton
relating to Workman's Compensation Insurance.
11,c,pt Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
WN
SIGNATURE � ;I ZONT) BXTT-13IGNED
NOTE: Applicant Siibject to Plait Check, Fee
-------------------
This permit covers work to be done on private ProlCrtY ONLY.
Any construction on the public domaln (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisnion.
ZONE
0 YES
kP No.:
nul"U""
PERMIT
I
NUMBER
(yj .
STREET SETBACK
701M
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
FEE
AMOUNT DUE
ATWNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
I
650450
d r 7
REAR YARD BET13AL
V-A—CAZU SITE
jj YES 13 NO
VARIANCE NUMBN"
[3 YES E3 NO
M
I 1 .01 . 1� I
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 acknowledged in space provided.
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