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INUMBER OF ST0_1UE
NEW SIGN
DEMOLISH FENCE
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL I 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-
laung 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) DATE SIGNED
C��* �_ a - , 16 _A� - /0 C E
NOTE: Pfpplicant Subject to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs. sidewalkn, drivewaym,
marquees, ate.) will require! separate pennimsion.
IOSTED ON KROLL MAP NO.: BUILDING
PERMIT 660244
NUMBER
OB ADDRESS
777,-o— 'e'� >, ",/ -
SIDE Y RD 8FrBACK STREET SETBACK REAR YARD JETBACK
A-S
USE! ZONE LOT AREA VACANT SITE
P,�— E---- 113 YES 13 NO
HEIGHT BUILDING AREA VARIANCE NUMBER
PLOT PLAN APPROVED
[] YES [:] NO
BUILDING
1
VALUATION
BUILDING PEIRMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
81
AMOUNT DUE
ATTENTION
THIS PEMUT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1101
13 YES 13 NO
15�'
I I 15'� &-v 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 acimowledged in space provided.
_Z' _z.
FILE
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