660001.pdfPOSTED ON KROLL MAP NO.: BUILDING
BUILDING DEPARTMENT
PERMIT
I
AppIlcant Fill
NUMBER
PERMITAPPLI Inside Heavy Lines
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
4' /S�
—
SIDE YARD SETBACI
STREET SETBACK
REAR YARD SETBACK
C4
&el
MAILING ADDRESS
:2 f
4
USE ZONE
1
LOT AREA
VACANT SITE
CITY TELEPHONE NUMBXR
YES 0 NO
HEIGHT
BUILDING AREA,
VARIANCE NUMBER —
NAME
PLOT PLAN
ADDRESS
4-If
�FV
REMARK
CITY TELEPHONE NUMBER
NAM
REMARKS
-ID—DRE38
METER SIZE SERVICE
SIZE CLEARANCE
CHECK Mi BY
CITY TELEPHONE NUMBER
REMARKS
STATE LICENSE NU—MBER CITY LICENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST
PERMIT NUMBER
[] YES
PLA14
WORK TO BE DONE
I
BUILDING
VALUATION
BUILDING PERMIT
FEE
2
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NEW
ADD
DEMOLISH
SIGN
FENCE
NUMBER OF STORIES
5
—
SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
04
ALTER
RESIDENTIAL
NUMBER OF (1
1:1
REPAIR
1 0— NON-RESIDENTIAL
DWELLING
I UNITS
7
PLAN CHECK
FEE
11
AMOUNT DUE
he
I hereby acknowledge that I have read this application; that the In-
reb
n givy '
formation given Is correct; and that I am the owner, or the duty author.
en
ATTENTION
Ized agent of the owner. I agree to comply with city and state laws regu-
as I
r1atingcomstructlon; and in doing the work authorized thereby, no person
w
will be employed in violation of the Labor Code of the State of Washington
in
relating to Workman's Compensation Insurance.
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
N OT �erj (Except Demolitions which shall
OTE: Permit Limit One Year be completed in ninety days.)
BIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subicct to Plan Cbeck Fce
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb%, sidewalks, driveways,
marqueex� etc,) will require separate permission,
113 YES E3 NO
4CY GROUP
I
.0
9
APPLICATION APPROVAL
This application is not a perntit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged In space provided.
I
All
It
r I
I, I r
I d
?�q i, 't A. �71 4, �fa I
L I
P 4
I I r d I
p I I I
kt
f4�
tI I r I
I d
rr r 4 4
14
I k
"I
j,
Ot VA 1 1
r, d L L I I
I L It
I p