660167.pdf'OSTED ON KROl
'N'BVILDING DEPARTMENT
I Applicant MR
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PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
NAM9 (OR NAME OF BUSINESSI
pant F
lie T
H _avy L
e
4 � 6 1 SIDE YAIjD sEyr
_� 6 id
.7YWLaNG ADDRESS
4—
LVIEM Z-01-TE
*XN�r�ONE 7NUmBER
CITY: S',
HEIGHT
PLOT PLAN APPI
Z
Z
NA
e- /I
I
NEW D SIGN
ADD I DEMOLISH FENCE
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
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.
1111,pt Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days,)
1IGNATUPLE (OWNER OR T) DATE SIGNED
NOTE: Applicant Subject to Plait Check r4ec
This Pen"It covers work to be done on privatto propr.rty ONLY.
Any construction on the public domain (curbs. sidewalks, drivemaym,
marquees. etc.) will require. separate pernilmsion.
FIRE ZONE
SPECTAT, 11
[] YES [j NO
BUILDING
1
VALUATION
BUILDING PERMUT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
NO.:
BUILDING
PERMIT
NUMBER 660167
REAR ��"D SETBACK
'T
VACA.NT SITE
[3 YES Ij NO
VARIANCE NUMBER
[:] YES 0 No
I I -:57CLd I
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 aclmowledged in space provided.
FILE
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