660202.pdfr
-D ON KROLL MAP NO.:
BUILDI NG
PERMIT
660202
BUILDING DEPARTMENT
Applicant Fill
NUMBER
iWFIRMIT APPLICATION
Inside Heavy Lines jOB
ADDRESS
N Usi as)
Z 3,�l
7-7 7
",',on
YARD SET13ACYI
STREET IMT�AUK
RE AR YARD SETBACK
" : ,
SIDE
USE ZONE
LOT A A
VACANT SITE
TELEPHONE NUMBER
I
YES
HEIGHT
BUILDING AREA
VARIANCE NUMBER
PLOT PLAN APPROVED
P4
'71E
'ADDRESS
REMARKS
TELEPHONE NUMBER
Rl
REMARKS
Q
�2 -5-
METER SIZE SERVICE SIZE CLEAIIANCE BY
ICHECKED
TJf.LEVJ1U14N NUM13ER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED By
our
�Legal Description of Property (Show Below or Attach r Copies)
71
PERC. TEST PERMIT NUMBER
Z
FIRE ZONE TYPE OF CONSTRUCTION
STR T IMPROVED
[3 YES [3 NO
Ile
', -r .# kc R
A/ — /--ug
NAEDWD
SIGN
I
DE2sH
I HFENCE
R
RESIDENTIAL
NUMBER OF
REPAIR
NON -RI
DWELLING
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-
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.)
7— 66/o
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to he done on private property ONLY.
Any construction on the public domain (eurbs, sidewalks, drivewayn.
marquees, etc.) will require mrparate pernilmmlon.
0 YES 0 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE,
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE:
8 1 AMOUNT DUE
ATTENTION
THIS PEnrIIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
�� � 49-6)
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.
77
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