650496.pdf1, L,D I N
PERMIT
DEPARTMENT
APPLICATION
'07
EP
Im
X-A4 A V
iF
CENSE NUMBER
Legal Description of Property (Show
Applicant M
inside Heavy Lines
'774-/ 74 tO
or
L L!S
NEW
LJ SIGN
ADD I
DEE]SHI
MOLI
El PENCE
ALTER
RESIDENTIAL
NUM13ER OF
I
El
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read.thls 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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
ri
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (turbo, sidewalks, driveways,
marquees, etc.) will require separate permission.
IF.;? 7—
/0 71--
��ONE
y— / 7--�
'14t,
1110
YES
11 VALUATION
BUILDING PERMIT
2
FEB
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FBB
E A W" 0 Y, m i R V g 911 g�
ATTENTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Kc
W4��_ & I
t YARD SETBACK
.7-1
[3 YES (3 NO
VARIANCE NUMBER
.7 5/0
YES [3 xO
_3�
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 acknowledged in space provided.
14
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