660098.pdfBUILDIN6 DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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3 r, E
MAILIN
G ADDRESS
6�i-ol - 21V 5�, W,
CITY TELEPHONE NUMBER
1319 - P2 63
lit 6
Irk, NA1ilil
TELEPHONE NUMBER
C Y
-i -J737
FA ADDRESS 7,
ADDItEdd
I i 1 /,9 // L4 7
IIERLtIT
NUM13ER 660098
JOB ADDRESS
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SIDE YARD SETBACK switFE—T —SETBACK REAR YARD SETBACK
USE ZONE �U` AREA
"s 0 No 0
I:ER:
HEIGHT BUILD AREA VARIANCE 14U
-1 --_ -1 A �V.n I I
9-17S7 REMARKS
M13E
SV�TE LICENSE NUMBER CITY LICENSE NU
T YPE CONNECTION
L=srrltptlo��f Property (Show HOW or Attach Four Copies)
C cor of Gov Lot 4,, Sec 18 T27N PERC. TEST PER T
ME Wm; Th !1 00'15130" E aig the E; In ef
sd Lot 174.861; th W 189.161 to the TPB; FIRE ZONE TYPE OF CONSTRUCTION
th W too I i th a tj -0. J.1, to N t1i of t9 1 722!�� -
SW; th S 89039120" E alg the N 1n of sd SPECULL—INSPECrom nEwUIRED OCCUPANCY
street IUU'; th N lb3.711 to PUB. [3 YES 0,fro
WORK TO BE DONE
I
VALUATION
BUILD qG PERMIT
FEE
2
7LUMBRITG
3
PERMIT FEE
HEAT & GAS LINE
Z
4
PERMIT FEE
SIGN PERMIT
FEE
NEW
I El
ADD I DEMOLISH
13 SIGN
El FENCE
NUMBER OF STORIES'
5
—
DEMOLITION
PERMIT FEE
ALTER
REPAIR
N RESIDENTIAL
NON-RESI1
NUMBER OF
DWELLING
UNITS
6
7
PLAN CHECK
FEE
81
AMOUNT DUE
I hereby aLcknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
ATTENTION
lzed agent of the owner. I agree to comply with city and Ante laws regu-
lating construction; and in doing the work authorized thereby, no person
Tins rERM]IT
AUTHORIZES
will be employed In violation Of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
ONLY THE
WOME NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIGNAT JRE (OWNER 0 1 R AUNNT) DATE SIGNED
�J
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: AFPlicant Subject to Plan Check Fce
Pit 6-1107
This Permit covers work to be done on private Property ONLY.
Any construction on, the public domain (curbs, sidewalks, drivewaYs.
n1m,quecs, etc.) will "quire separate permission.
0 TEO [:] No
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I I _<��, ro 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
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