660009.pdfIOSTED ON KROLL MAP NO.: 13UILDING
BUILDING DEPARTMENT PERMIT 66004
Applicant Fill NUMBER —
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS ;2 /,F o JC — f97 "�' �VZ r
NAME (OR 14AMN ob- iffi—SINESS) Z;2
SIDE Y�RD SETBACK STREET SETBACK Enr—YARDBETBA-0—K
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MAILING ADDRESS
USE LOT AIMA VAU�K OLA
NUMBER
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NAME
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CITY �l TELEPHONE NUMBER
NAME
REMARKS
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1-1 RL Uj e- S METER SIZE SERVICE SIZE
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STATE CENBE NUMBER CITY "CENSE NUMBER
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Legal DescrIP1
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0 YES 0 NO
BUILDING
WORK To BE DONE
VALUATION
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BUILDING PEEIRIMUT
FEE
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
0
2
Q
5
NEW
0 ADD
DEMOLISH
SIGN
FENCE
NUMBER OF STORIES
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SIGN PERMIT
FEE
6
DEMOIATION
PERMIT FEE
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NON-RESIDENTIALI
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UNITS
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PLAN CHECK
ElREPAIR
PROPOSED USE
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AMOUNT DUE
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-
ATTENTION
ized agent of the owner. I agree to comply with city and state laws regu.
THIS FERBUT
lating COUfitructl0a; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
AUTHORIZES
ONLY THE
relating to Workmon!d Compensation Insurance.
WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
BIG UZ j DATE BIG NED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chech Fee
Pit 6-11011
This ]Permit c0vM work to be done on private PrOlNertV ONLY -
Any construction on the public domain (curbs, sidewalks, driveways,
murquees. etc.) will requirr separate Pen"I"AlOn-
[] YES (3 ITO
I I 71,�5-n I
APPLICATION APPROVAL
This application is not a pem-dt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
FILE
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