660159.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NA (OR NAME OF BUSINE
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Applicant Fill
Inside Heavy Lin 9
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POSTED ON KROLL MAP NO.:
BUILDING
PERMIT
1
660159
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.
NUMBER
JOB ADDRESS
11
SIDE YAR SETBACK
STREET SETBACK
REAR YARD SETBACK
-Apr
U59.,,,ZONE
LOT 5U—MA
VACANT SITE
1
1 13 YES (3 NO
NEW
F1
Lj SIGN
ADD I
DEMOLI SH
I
ALTER
RESME14TIAL
NUMBEIR OF
I
F-1
REPAIR
F�
NoN-nESIDENTIAL
DWELL NO
UNITS
� e-s 1(f e v a
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-
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 Irsurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
lIGNATURE (OWNER DATE SIGNED
A,�
N&ENMENE
NOTE: Applicant Subject to Plan Chcck Fce
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbso sidewalks, driveways,
marquees, etc.) will require separate permission.
t(
[3 YES
I I VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LiNi
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
81 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pit 6-1107
[3 YES 13 NO
-A
eq e2-
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.
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