660351.pdfKROLL I
G DEPARTMENT J."Applic t oil
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ERMIT APPLICATION V7
(OR. NAME OF BUSINESS)
1., 4, Hlel SIDE YARD SET�AC
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Lehal Description of Property (Show Below or Attach Four Copies)
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0 140 e� ra,461 FIRE ZONE TYPE OF
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PLAN CHECKNU ISX
BUILDING
WORK TO BE DONE I VALUATION
ILDING PETRMIT
2 FEE
PLUMBING
3 PERMIT FEE
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0 HEAT & GAS LINE
STORIE13 4 PERMIT FEE
SIGN I NUMBER OF SIGN PERMIT
5 FEE
0 ADD EE28H El FENCE DEMOLITION
0 OF 6 PERMIT FEE
0 RESIDENTIAL R —
ALTER 0 N=E LINGF CHECK
F-1 REPAIR NON-RESIDENTIAL I UNITS 7 FEE
ITR—OPOSED USE
8 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION
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 rCgU- THIS PERMIT
lating construction; and In doing the work authorized thereby. no person AUTHORIZES
will be employed In violation of the Labor "a of the State of Washington ONLY TIM
relating to workmen's Compensation Insurance. WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit Arie-TkIar be completed in ninety days.)
I', INSPECTION
— (0% IE OR ENT), D TE SIGNED
S711NA:!;URE (OW11 1_� DEPARTMENT
MY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee Pit 6-1107
This permit covers work to be
Any construction on the public domain (curbs, sidewalks, driveways.
marquees, etc.) will rt-quire neparate perrulaxion.
C k
PERMIT
NUMBER 660351
-9—ETBACK j_jE9XR YARD B
0111M�B [3 NO 0
VARIANCE NUMBER
[] YES (3 NO
2-
I
I 19'/, 4�? 191
APPLICATION APPROVAL
This application is not a permit Until
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
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