650465.pdfR
BUILDING DEPARTMENT
POSTED ON KROLL MAP NO.:
BUILDING
PERMIT
650465
PERMIT APPLICATION
Applicant M
Inside Heavy Lines
JOB ADDRESS
NUMBER
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NAME (OR NAME OF BUSINESS)
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SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
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MAILINGADDRESS
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USE ZONE
LOT AREA
VACANT SITE
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ADDRESS
CITY
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TELEPHONE NUMBER
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CITY
TELEPHONE NUMBER
13TATE LICENSE NUMBER
CITY LICENSE NUMB]
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1 Legal Description of Property (Show Below or Attach Four Coulee)
WORK TO BE DONE
NEW I
ADD
DE M
MOLI
SRI
E' SIGN
Ej PENCE
NUMBER UF-81
ALTER
RESIDENTIAL
M OF
rWE
ElREPAIR
I El
NON-RESIDENTIAL
LER
NG
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given In 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 Workman's Compensation Insurance.
11X1,11 Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
3IGNATURE (OWNER OR AGENT) DATE SIGNED
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NOTE: Appl;cant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on the public domnin jeurbs, sidewalks, driveways,
marquees, etc.) will require neparate permimsion.
0014*oi
[j YES 0-116
I I 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
7
FEE
8 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
A_4&� 9
'NUMBER
,2
0 YES [j NO
1 1 V3, C�) 0 1
APPLICATION APPROVAL
This application is not a permit untII
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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