660322.pdfPOSTED ON KROLL MAP NO.: BUILDING
BUILDING DEPARTMENT Applicant M j5- PERMIT 860322
NUMBER
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
0 C-11 I?
Is
SIDE YARP, SETBACK
STREET SETBACK
REAR YARD SETBACK
MAILING ADDRESS
�71/
us ONE
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HEIGHT
LOT AREA
I
BUILDING AREA
VACANT 81
I W, rs 13 NO
VARIANCE NUMBER
CITY
TELEPHONE NUMBIaR
NAME
PLOT jel-AX, APPI�WED
DRE
CITY
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ADDRESS
METER 5: R: CLEARANCE CHIN>ED BY
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CITY
TELEPHONE N
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
I
TYPE NNECTION VERIF1 Y
Legal Description of Property (Show Below or Attach Four C Is
L47
ERC.IrEST PERMIT�,�BER
2�,2 /9 6-4-0) 1A44 ;2n Z��I) 7-
Z
0
Q
I= ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES �5�0
IV Ila Z, /,I- �5;,4:'
SPECIAL INSPECTOR REQUIRED
YES
OCCUPANCY GROUP
PLAN CHECKED Ex
72/1-- LA Z r�ll
P,4W41,1 ZZ /71 7112' Z,_4 �7_ IJVZ- efz�
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BUILDING
VALUATION
Z
WORK TO BE DONE
Z
2
BUILDING PERMIT
FEE
;0
0
t
3
PLUMBING
PERMIT FEE
;6i
rn
c9tq, 47-0
4
HEAT & GAS LINE
PERMIT FEE
NEW
ADD
DE28H
SIGN
FENCE
NUMBER OF STORIES
5
SIGN PERMIT
FEE
—
6
DEMOLITION
PERMIT I=
F]
ALTER
REPAIR
I J71
L"\j RESIDENTIAL
El NON-RESIDENTIAL
NUlffll, OF
DW LING
I UNITS
M
7
PLAN CHECK
FEE
PROX
.1)j#1V,4-,A�S _ /%/
8
81
AMOUNT DUE
in
I hereby acknowledge that I have read this application; that the in-
th
formation given Is correct; and that I am the owner, or the duly t author- ATTENTION
ly an or
APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu. THIS PERMIT
erso
on
IaUng coluitruction-, and in doing the work authorized thereby, no p n AUTHORIZES
w �j
ill be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety d eye.
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.
6 __-
SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
77 DEPARTMENT
CITY OF
EDMONDS
�01TE: APPlicant Subject to Plait Check Fec
pit 0-1107
DIRECTOR'S SIGNATURE
/�
�4�e
DAT
FILE
This permit covers work to be done on private property ONZY-.
Any construction on the public domain (curbs, sidewalks, driveways,
nuLrquees, etc.) will require separate perminslon.