650493.pdf'08TED ON KROLL MAP NO.:
BUILDI DEPARTMENT AppUcant FIB
Inside Heavy lAnes as
PERMIT APPLICATION "7 2 S'
NAME (OR NAME OF 8 so)
SIDE YAR STRE
BETBAC
I
U ZONE
0 PROW NUMBER E
HEIGHT BUIL
P
I
U
E
Z
R
E
L
N
D
M
G
0
N
q
A
0
G
7 6� Of
NAME
PLOT PLAN A ROV
So Al -I
7 7�DRESB
2-1 1 REMAR]OK
l?7 6 Igoe, - lva�r&
C C Zr Till ONE NUMBER
09 1
NAME MARKS
TPN:40.411 -�- S
ADDRE 38
METER E
NUMBER
PHONE
7%ZO� 1446 6-9,;)-2
STATE LICENSE NUMBER C1 -LICENSE NfUUMBER
TYPE CONNECTION
Descripti v Below or Attach Four Copies)
0 IC6 LV rz7N'. PER.C. TEST
A/" czeR
FIRE ZONE TYPE OF Go
SPECIAL INSPECTOR J%EF4U1
YES Gwqy�
NEW
I LJ SIGN
AD.
El FENCE
�ALTER
RESIDENTIAL
NU OF
LER
D'X tJNG
F-1
REPAIR
NON-RESIDENTIAL
UNITS
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-
I&tlng construction: and to doing the work uuthorized thereby, no person
will be employed in violation of the Labor Coda of the State of Washington
ralallog to Work=eWn Compensation Insurance -
(Except Demolitions which shall
NOTE: Pewit Limit One Your be completed In ninety days.)
NOTE: Applicant Subject to Plan Check Fee
rt
JCWp Permit coven work to be done On Private PrOPe Y ONLY'
Any construction an the public domain (curbs, sidewalks, drIvVw"A,
nuLrqUfts, etc.) will require separate Permission-
PERMrr
NUMBER 6bU4VJ
0� 7 IALO.� I
SETBACK REAR ARD, BETB
7 / .e.— P ACY,
0A VACANT SITE
13 YES 13 NO
FGAREA VAJUAN�19 14U5M"MNn
U�.T �s 0 ITO
B=1TNJG
V ON
J
'IMEM-REM
Z
BUILDING PERMT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT I=
PLAN CHECK
7
FEE
—81
AMOUNT DUE
1,9 0 d2
ATTENTION
APPLICATION APPROVAL
TIUS PERMT
This application Is not a permit until
AUTHORIZES
signed by the Director of Building 1nSPeC-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
1140 A