660256.pdfBUILDING DEPARTMENT I Applicant FM
PERMIT APPLICATION Inside Heavy Lines
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ZARD SETBACK
Description of Property w jseiow or AtEaCa MOUr UOPICO; PERC.
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NEW 1:1 " SIGN
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ADD I DEMOLISH 1 1:1 FENCE
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ALTER
RESIDENTIAL
=ER OF
nREPAIR
NON-RESIDENTIAL
UNITS NO
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duty allthor-
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 Umit One Your be completed in ninety days.)
ER PLLAGENT)
DATE SIGNED
.,u,R,E7
NOTE: Appllrcan7 Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
numquees, etc.) will re.quire separatr permission.
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
AT=NTION
TIHS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
13UILDING
PERMIT
660256
NUMBER
�-r SETBACK I REAR YARD BETBACKI
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 acknowledged In space provided.
DIRECTOWS SIGNATURE
DATE
FILE
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�'APKJGATION bUILDING PERMIT Appl. No. ............
Permit limit, one year
BulkUng Department
MONDS
VffY OF ED
to construct the following work, in accordance with the accom,
AMC ON is hereby made for a permit
ATI
...... for approvaL
and specifications. Two are submitted herewith
-plai"
Off-st
alter
...... Parking ......................
......................................
,i!:Vaiddn "Xrzair .................. ................. .....
-e zone ... %5 ... Fire zone ...........................
.... Const. type ................................ Us ......................
.. . . . . .............
......................
........................ Blk ....................... Addn .................................
. .............
... Septic tank .................................. ....... ..
...... Area ........................................
.......... ...................
ide.............................. rear ...............................
aetbacksfront ........................... r. side ............................. r
No... . . ................
......................... Address ... Z42-4--1 ....
J,
. ...........
All
..... Tel. No .............................
.....................................
Address ..........
Plansby .................................................................
.................... ................................. .......
Remarks. ..................................................................................................................
. . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . .. . . .. . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. . . .... . . . . .
. . . ..... . .. .. . . . . . . ... . .. .... . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . .. .. . . . . . .. . . . . . . . . . . . . ..
. . .. . . . ... .... .. . ..........
. . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . .
. .. . . .. . . ... . .. . . . . . . .. . . . . . . . . . . .. . . .. . . . .. . . . . . .. . .. . .. ...... . . . . .. . . . . . . . . . . . . .. . .
. . . .. .. . . . . .. . . .. . . .. .
regulating this
a rect statement, and I agree to comply with all applicable Codes and State laws
The above is cor
work.
Date.
Signed Owner/Agent. 4 ----- - �, iddress ... I ..................
ed, subject to the above conditions, and to compliance with the ap-
PERM for the above work is hereby approv
thereon.
proved plans and specificationN and Building Department notations
fee ....... .. . ...... Recd. by ......
Valuation .................................................... Permit ..... 4
.........
.............................. ......... /.-,/
Building Department, By .................. 41jr. ........ Date ....... ............................. ......
Two su,
sewer or Electrical installations.
This Permit does not cover Plumbing,
' I