650490.pdfi
BUILDING DEPARTMENT Applicant FM
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
Cb �a- t_ P_5� . �-/ 2 17's I? q
MAILING ADDRESS
CITY TELEPHONE NUMBEIR
Ed-M 0 n P1, k 7 Z4-5- 2�
NAME
gai Description ox rroperty tbnow miow or
L o -/— —3 1) ; v , -'I-
xr-, 1- 13 %zl --/I--
I
POSTED ON KROLL MAP NO.: BUILIVANU V__
PERMIT
NUMBER
JOB ADDRESS
9 f &/
SIDE YAPP SETBACK STREET SETBACK HEAR YARD BET13ACMX
/4� # -,;kj � J/-
USyr,�ONE LOT AREA VACANT SITE
/01� ,/ 2
"� 1 [3 YES NO
HEIGHT BUILDING AREA VARIANCE) NUMBER
I PLOT PLAN APPROVED ':;�'
PA
NEW
M
I SIGN
E]
ADD I
DEMOLISH
1_ FENCE
ALTER
RESIDENTIAL
NUMBER, OF
I
REPAIR
NON-RESIDENTIALI
DWELL NG
UNITS
REMARKS
METER SIZO I SERVICE SIZE I CLEARANCE CHECKED BY
REMARKS
C_S��
TYPE CONNECTION VERIFIVD By
PERC. TES-F
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-
e In-
"hor-
r u-
: on
lating construction; and in doing the work authorized thereby, no person
I
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Inaurance,
IEIC,pl Demolitions which' shell
NOTE: Permit Limit One Year be completed In ninety days.)
I __
SIGNATURE (OWNER Oft AGE T) DATE SIGNED]
NOTE: Aptlicant Subject to Plan Cbeck Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveivaytt,
marquess, etc.) will require separate permission.
SPECIA.
[3 YES
1 1 VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LaNE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
ATTENTION
TIUS PERSIXT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 6-1107
0 YES 0 No
9
7,7 S-e U
Ck
APPLICATION APPROVAL
This application Is not a permit until
signed by the Director of Building InSNC-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
FILE
RECORD of: I
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