650472.pdfPOSTED ON KRO MAP NO.: I BUILDING
BUILDING DEPARTMENT Applicant Fill
Insido Heavy Lines
j,:, PERMIT APPLICATION JOB ADDRESS
OF BUSINESS)
XAMII (OR N
NAME (OR SIDE YARD SETBACK
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YE—LEPHONE N
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Sit
ITY
ME= SIZE SERVICE
CITY TELEPHONE NUMBER
PIZ
REMARKS
STATE LICEN13E NUMBEft CITY iLMNSE NUMBER
TYPE CONNECTION
Legal Description of Property (show Below oF_Att"_h Four Copies)
C.'i
PERC. TEST
w-k 0 ckt 0
FIRE ZONE TYPE
SPECIA.L INSPECTOR R
F-1 YES 0 NO
PLAN CHECKED BY
BUILDING
WORK TO BE DONIG
VALUATION
Z7
BUILDING PERMIT
2 FEE
PLUMBING
Z
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
NUMBER OF STORIES
SIGN
SIGN PERMIT
0
NEW
5
ADD PENCE
FEE
DEMOLITION
ALTER RESIDENTIAL I OF
�U7EZLI�G
6 PERMIT FEE
—
W,
NON-RESIDENTIAL I UNITS
PLAN CHECK
7
REPAIR
FEE
PROPOSED U13E
8
rAMOUNT DUE
I hereby acknowledge that I have read this Application; that the In-
ATTENTION
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-
THIS PER311T
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
will be employed In violation Of the Labor Code of the State of Washington
ONLY THE
relating to Workmens Compensation Insurance.
WORK NOTED
,Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
GNAT ;OR AGFNT) I DATE 81 GNED
INSPECTION
DEPARTMENT
cc
CITY OF
EDMONDS
NOTE: APPlicant subject to Plait Check Fc.-
PR 6-1107
This Permit coverei work to be done on private property ON-Ly-
Any construction oil the public domain (curbs, sidewalks, driveways,
marquem etc.) will require separate permission.
PERMIT
NUMBER 050472
610
ArK I REAR YARD SEI
0 YES
0 No
PA
to
[j YES 13 NO
FICK
1 1 .3" 6LC) 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 aclmowledged in space provided.
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