650494.pdfil"
POSTED ON KROLL MAP NO.: BUILDING
PERMIT 650494
BUILDING DEPARTMENT
Applicant Fill
NUMBER
Inside Heavy Lines
PERMIT APPLICATION
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
740'�;�a
J-41US E)9N(f #65e
=IDE YARD SETBACK
STREET SETBACK REAH, YARD BET13ACK
d6.
MAILING ADDRESS
3(7-t.+
UCIE ZONE
LOT AREA VACA SITE
CITY TEWUPHUNE NUMBER
0 YES [3 NO
tote e — 4/9 4`1
HEIGHT
BUILDING AREA VARIANCE NUM33 Ell
NAME
PLOT PLAN APPROVED
;10
ADDRESS
REMARKS
TELEPHONE NUMBER
NAM
W MP4 REMARKS
ADDRESS
METER SIZE SERVICE
SIZE CLEARANCE CHECKED BY
CITY TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER CITY LICENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
Stz_� A EZAC11,62? QdPI,41
PERC. TEST
PERMIT NUMBER
Z
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES [3 NO
PLAN CHECKED BY
VALUATION
TOTAL I'M
BUILDING
VALUATION
WORK TO BE DONE I
Irzoode llvrA6�juae
BUILDING PERMIT
FEE
2
3
PLUM13ING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NEW
SIGN
NUMBER OF STORIES
SIGN PERMIT
ADD
I H FENCE
5
FEE
1`77110`�
DEMOLITION
PERMIT FEE
FL;KRESIDENTIAL
N U' Ro F 6
ALTER
LE
PLAN CHECK
ING
UNITS
REPAIR
NON-RESIDENTIAL
7
FEE
PROPOSED USE
8
AMOUNT DUE
I hereby acknowledge that I have read thin applicallon; that the In.
ATTENTION
APPLICATION APPROVAL
formation given In correct; and that I tam the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
This application is not a pernitt until
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Waahington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
(l,c,,l Demolitions which shall
Permit Limit One Year
receipt is acknowledged in space provided.
NOTE: be completed In ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIREC
DEPARTMENT
CITY OF
EDMONDS
DATV�'
NOTE: Applicant Subject to Plan Check Fee
PH 0-1107
Title Permit coven work to be done oat private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
marquees, etcJ will "quire nepoeste permission,