660059.pdf660059
POSTED ON KROLL MAP NO.:
BUX
'L G
BUILDING
B
DEPARTMENT
P A I
T
Applicant Fill
r 11-
1
FERWaT
I NUM13ER
PERMIT
ER
APPLICATION
A
P��
'Cl
Lines
inside Heavy Lines
OB ADDRESS
� !
7
NAME, (0
OR
OF Los)
;DI'N
EDE
SIDE
YARD SETBACK
STREET BET33ACK
YARD SETBACK
jR YARD SETBAM
REAR
E
NG ADDRESS
6.1
IF
J14
U ZONE
LOT AREA
VAUA14T bl-01i
7T
('10 1
N.
1 E3 YES Cl NO
"..
CITY —
XAI�V=V..
kr
HEIGHT
BUILDING AREA
VARIANCE NUMBER
NAME
I
— 'FL—OTPLAN
APPROVED
f
or
- A �� If
I
IU4.(6 jeq // Y)
MNEW I DEE] 8, [:J SIGN NUMBER OF STORIES
ElADD MOLI El FENCE
MALTER RESIDENTIAL NUM33ER OF
1 1-1 DWELLING
F1 REPAIR 1:1 NON-RESIDENTIAL I UNITS I
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.
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 Your be completed In ninety days.)
NOTE: APPlicant Subject to Plan Check Fee
This permit covm work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewayst
marquees, etc.) will require separate permission.
[] YES
[3 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7 FEE
a I AMOUNT DUE
AWENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[] YES 13 NO
4��' &-%�
1 1 400" , &-& I
APPLICATION APPROVAL
This application Is not a pernitt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in Space provided.
I
— /_J_�
FILE
I