660389.pdfBUILDING DEPARTMENT Applicant Fill
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Inside Heavy Lines
PERMIT APPLICATION Heavy Line,,
POSTED ON KROLL MAP NO.: BUILDING
PERMIT
I NUMBER 660389
JOB ADDRESS
NAME (OR NAME OF BUSINESS)
M
SIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
UNNG ADDRESS
USE ZONE
LOT AREA
VACANT SITE
1;;ES [3 NO
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CITY
Wcus
TELEPHONE NUMBLR
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BUILDING AREA
VARIANCE NUMBER
NAME
PLOT PLAN APPROVED
04
ADDRESS
REMARKS
CITY
TELEPHONE NUMBER
NAME
REMARKS
ADDRESS
METER SIZE SERV�CE SIZE CLEARANCE
CITY
TELEPHONE NUMV R
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION
VERIME BY
Legal Description of Property (Show Below or Attach Four Copies)
q0 J 2, 3(0 30 116� 0� C'
PERC. TEST
PERMIT 17R
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AIC" (a. A10CV1,000r� V600C ACI. C1 CAC
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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IcLt +hetre,& irccor-Oec) in 0ol. it) ?6
_2:� 0 YES [j NO
SPECLALL INSPECTOR REQUIRED
YES aj'No
OCCUPANCY GROUP
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PLAN CHECKED BY
VALUATION
-TOTAL FKZ
1
BUILDING
VALUATION
e2
Z
WORK TO BE DONE
2
BUILDING PERMIT
FEE
3
PLUMBING
PERMIT FEE
C2
Z
4
HEAT & GAS LINE
PERMIT FEE
M
Er
El
NEW
ADD
1:1 SH
DEMOLI
E] SIGN
1 1:3 FENCE
NUMBER OF STORIES
I I
5
SIGN PERMIT
FEE
6
DEMOLITION
PERMIT FEE
ElALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
7
PLAN CHECK
FEE
PROPOE
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In correct; and that I am the owner, or the duly autbor-�
ATMNTION APPLICATION APPROVAL
lzed 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 Workmeu'a Compensation Insurance.
THIS PERBUT This application is not a permit until
AUTHOIUZES
ONLY THE signed by the Director of Building Inspec-
WORK NOTED tion, or his deputy; and fees are paid, and
(Except Demolitions which shall
I
NOTE: Permit Limit One Your be completed In ninety days.)
receipt Is acknowledged in space provided.
PECTION
INS DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
EDMONDS DATE
Pit (1-1107
SIGNATURE (OWNER OR AGEN
DATE SIGNED
NOTE: Applicant Sitbiect to Plan Check Fee
This Permit covers work to be done an private property ONLY.
Any construction an the public domain (curbs. sidewalks, driveway".
marquees. etc.) will require separate permission.
FILE
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