660162.pdfI4PILDING DEPARTMENT Applicant IM
gPERMIT APPLICATION Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)
MMJNG ADDRESS
71 NUMB0F__
2—
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Description of Property (Show Below or
AdO 7-
4-bD
4-If-7-1 4
NEW I DE [] SRI SIGN NUMBER Or" STORI&
Fr
M Q ADD moil NCE
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPLIR NON-RESIDENTIAL I UNITS
PROPOSED USE
7-4v /Z /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-
lzed 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.)
SIGNATURE (OWNER OR AGENT) IGNED
.07
NOTE: Applicant Subject to Plan Check- Fee
This Permit covers work to be done on private Property ON
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pernilsslon.
PERMIT 660162
NUM13MR
OB ADDRESS
1IDE YARD SETBACK
BEAR YARD SETBACK
USE ZONE
LOT AREA
VACANT 131TE
NO
YES
a
iEI - GHT
BUILDING AREA
VARIANCE NUMBER
04
?LOT PLAN APPROVED
IEKARKS
REMARKS
METER SJZU SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
99
PERC. TEST
PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
[j YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
[3 YES NO
BUILDING
VALUATION
Z
�i
2
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE)
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspee-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space provided.
INSPECTION
—DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
DAre"
EDMONDS
PH 6-1107
FILE
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