660021.pdfPOSTED ON KROLJ, MAP NO.: BUILDING
PERMIT
BUILDING DIIARTMINT AppUcant FIR I NUMBER
InsIde Heavy Lines JOB A.DDRESS
PERMIT APPLICATION
V— ;2 `57
NAM (OR NAME OF BUSINESS)
SIDE YARD SETBACK I STREET SETBACK I
AI' '/0"? 4� T� "., I I
660021
Xf A ILING ADDRESS �7 r
LOT AREA
VACANT SITE
3A _2NE
CITY TELEPHONE NUM13
13 YES 0 NO 0
Til �'"_
141 6 7 -/ HEIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLA_U1A7RR0yED
?-" 1 /,1 .1., e� 'e
PERO. TEST
FIRE 7ONE TYPE 0
Z '111�1/:�7
14V
SPECIAL INSPECTOR B
0 YES
7-6 /f
PLAN
CHECKED BY
17
BUILDING
VALUATION
WORK To BE DONE
7—.)
BUILDING PERMIT
2
FEE
PLUMBING
Z
3
PERMIT FEE
0
HEAT & GAS LINE
4
PERMIT FEE
NEW
ADD
I
DEMOLISH
SIGN
1 10:1 FENCE
NUMBER OF STORIES
7-
/_3
1
5
SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
QALTER
1:1 REPAIR
1 Q
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING i
I UNITS
6
7
PLAN CHECK
FEE
PROI
1"/ rZ,
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In 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.
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.
TIUS PERMIT
AUTHORIZES
ONLY T1IZ
WORK NOTED
1111,pl Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY Or
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
FIC 0-1107
This Permit covers work to be done on private property ONLY.
Any conntruction on the public domain (curbs, sidewalks, drivewayn,
marqueen. etc.) will require separate pernilssion.
D YES [] I -to
FEE
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 aclmowledged in space provided.
DIRECTOR'S SIGNAT R
FILE
W
9
. . . . . . . . .. . . . . . ..
4
I r
L k
$it �l 4
t
p
It j
JI
?,I it,
1
A I? Air
it
I
. 11 4 . , , I I r I A . . I I I k
t qi
tt
41
d I
Lr
eol
d4
4�4 . . . . . . . . .
IL
r 110 r f
r"i
I
j 4
It I I
Ir
j
RECORD OF INSPECTIONS4, ' L�r ,:
4 Dat Pas I
L - , , y d
L p I r r L 1
roundation'
11
r
ft
r
I10, Igh)
r -n #3
at 71d
Furnace & Fuel Lines.
Final