660409.pdf...... . . ..... ...
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13UILDING
DEPARTMENT
PERMIT
APPLICATION
R NAME OF AUSINESS)
9/
I NT A` . _Z/
613
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or
Applicant Fill
Inside Heavy Lines
rubl'�" U11
PERMIT
660409
NUMBER-
JOB ADDRESS
SIDE YARD SETBACK
STREET sETBICK
REAR YAILD, SETBACK
;7 17, 1 4— 1
7t—
1 /�� 4-- -
USE ZONE
LOT AREA
VACANT SITE
[3 YES NO
HEIGHT
BUILDING AREA
VARIANCE NUM"Nn
I I/,- _711 -:� 4/
MT �� �T A � A vRnrLvr.n
I N
REMARKS
MMTE33,�IZE SERVICP SIZE CIMAkt"CE BY 04
T
R716ARKB
TYPE CONNECTION VERIFIK
FERMITTUrz
PERC. TEFT I
[:] YES
1
BUILDING
VALUATION
WORK TO BE DONE
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
M
5
SIGN PERMIT
FEE
NEW
Q ADD DEMPLISH
E, SIGN
0 FENCE
N MBER OF STORIES
DEMOLITION
ALTER
REPAIR
Q RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
0
PERMIT FEE
PLAN CHECK
FEE
PROPOSED USE
8
AMOUNT DUE
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-
ATTENTION
ized agent of the owner. I agree to comply with city and state laws regu-
THIS PEH311T
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
(EXCLpt Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
NATURE (OWN: OR T) 75AWN blu�m
INSPECTION
DEPARTMENT
CITY OF
EDINIONDS
NOTE: Applicant Subject to Plan Check Fee
pit (1-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will "quire separate Pernilmolon.
El YES [3 No
06
.01'�
1 1 _5�1 :a, . 6) 01
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.
FILE
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