660165.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION inside Heavy Lines
NAME (OR NAME OF BUSINEIIIII
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MA LING ADDRESS
CITY TELEPHONE NUMBIlu't
S-
NAME z7c�lGl—vi ;OL-d
VI.OLLU
—ID—DREBB
CITY I TELEPHONE NUMBER
17
NAME
Scot., itc, 0— n1er
1410
ADDRESS
ev
CITY TELEPHONE NUMBER
0771
Description of Property (show Below or AltaCn V
z.o 74- 6- Rt)-re ,fo6d
(-JaS4,
0 YES
7
NE
9
[3 NO
WORK TO BE DONE
1
VALUATION
2
BUILDING PERMIT
FEE
el-t
3
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
5
PERMIT FEE
NEW
ADD DEMOLISH
SIGN
FENCE
NUMBER OF STORIES
SIGN PERMIT
FEE:
6
DEMOLITION
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
7
PLAN CHECK
FEE
PROPOSED UQE
P&C Roo &Ir A., - fu -�v P e-
8
AMOUNT DUE
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-
ATTENTION
Ized agent of the owner. I agree to comply with city and state lawn 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.
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
(Except Demolitions which shall
NOTEA%rmit Limit One Year be completed In ninety days.)_
— 7- 7
ION URE (OWNERV AGENT) DATE SIGNED
01
INSPECTION
DEPARTi&ENT
CITY OF
EDMONDS
NOTE: Applicant Sitbicct to Plan Check Fee
PR 0-1107
This Permit covers work to be done an private property ONLY.
Any construction on Ole public domain (curbs, sidewalks, driverways,
marquees, etc.) will require seperatp permionjon.
BUILDING
PERMIT
NUMBER 660165
ACK REAR YARD ETBA
LREA VACANT SITE
13 YES 13 NO
)ING AREA VARIANCE NUMBER
I
[] YES 13 NO
DO
-joL;*�6 I /-:;t- .. � —4 1
APPLICATION APPRO"L
This application is not a peratit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
FWTKq.
3
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