660160.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
/I- AVILU .
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18
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NEW
SIGN
A
Lj ADD I
DE2SII
FENCE
ALTER
&I RESIDENTIAL
OF
F� RE PAIJ
F� NON-RESIDENTIAL
UNITS No
I hereby acknowledge that I have read this application; that tin -
formation given In correct; and that I am the owner, or the duly au or-
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 Year be completed In ninety days.)
11 TUBE (OWNER OR AGENT) DATE SIGNED
/Z
#'NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY
Any construction on the public domaln (curbs. sidewalks, driveways,
marquees, etc.) will require separate permission.
NO.
C�7
I
PERMIT 660160
'SETBACK AR YARD )ETBXZ
�0 / 2!�= 1 1_f� _�/_
LEA VACANW t5riM
1 13 YES 13 NO
METER SIZE SERVICE SIZE CLEARANCE C"CW BY
RKB
VE:::� Y
PERC. TEST PERMIT WBER
OF CONSTR
13 YES
e� �Ie
11 VALUATION
PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
tBUILDING
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
FEE
AMOUNT DUE
AT=NTION
THIS PER311T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[3 YES [] NO
I 6;-e:5� I
APPLICATION APPROVAL
This application Is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
_Cl� I
FILE
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