660114.pdfP
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BUILDING DEPARTMENT Appuc=tFm / )I
PERMIT APPLICATION inside Heavy Linjes—JOB —ADDRESS
NA3CRAOR ri^JLN OF Due
SIDE YARD SETBACK STRXI
G AD so /0" 1
USE ZONE
0 ONE NUMBER
LEF"
JL
re K E-- k HEIGHT
T j
FERN= t:)t)U I I&*
NUMBER
CI NO 0
ff WERff
— I
MARKS
ADDRESS
M30 rER SIZE SERVIC
CE CHECKED BY
CITY
TELEPHONE NUMB
STATE LICENOXI NUACUSAIM
CiTx LICAMSE NUMBER
TYPE CONNECTION
VERIFIED BY
I
maggal Descriptio of Property (Show Below or Attach Your Copies)
TEST
PERMIT NU3M1BM=R
WEE
Xy
FIRE ZONE TYPE OF CONSTRU
ON STREET IMPROVED
1 13 YES NO
MCIAL INSPECTOR REQUIRED
[3 YES 2-R-O---
OCU UPANCY GROUP
_T-
PLAN CHECKED BY
C7
VALUATION
TOTAL FUR
I
2
BUILD 0
VALUATION
BUILDING PERMIT
FEE
Z
6ORK
TO BE -DONE
3
PLUMBING
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
NEW
ADD
E3 1310
I DEE N
MOIASH E3 FENCE
NUMBER OF STTOIRUIES
5
SIGN PERMIT
FEE
6
DEMOLITION
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
0
NON-REBIDENTIAL
MDER OF
NUWELLING
I UNITS
7
P CHECK
FEE
-FR-0PoSED USE
a
AMOUNT DU!2�� >o'
I hereby acknowledge that I have read thin 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 comp . ly with city and state lawn regu.
tatting 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 Workmeti'm Compensation Insurance.
(Except Demolitions which sball
NOTE: Permit Limit One Your be completed in ninety days.)
ION _#ENT) SIGNED
S :x URE (O"fER 0!! A
1
NOTE: Applicant Subject to Plan Check Fee
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
This Permit coven work to be done On Private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FILM
marquees, etc.) will require NOPAMtP PermllsiOn-
7777777