660479.pdfBUILDING DEPARTMENT Applicant FM
PERMIT APPLICATION Inside Heavy Lines
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ROLL MAP NO.: BUILDING
PERMIT
NUMBER __ b604_79
j
USE ZONE LOW AREA VACANT SITE
NO
HEIGHT isuiLoiNG AltIUA VARIANCE NUMBRI"
PLOT PLAN APPROVED A
IV
I
LIU
NEW
ADD
Lj SIGN
DEMOLIS111 1:1 FENCE
ALTER
K RESIDENTIAL
ER F
M 0
NUWEB
I
RE- PAIR
M NON-RESIDENTIAL
LL ING
I UNITS
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-
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 Waahington
relating to Workmen's Compensation Insurance.
11,,,,1 Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
JIGNATURE (OWNER OR AGENT) DATE SIGNED
#reeg,4 sat 6&-V —, I 1�9 -1.1- 4 �
NOTE: Applicant Sitbjcct to Platt Check ree
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curb*. sidewalka, driveways,
rnmrqnees, etc.) will require Peparate permission.
it
or
[] YES [3 No
PLAN CHECKED By
BUILDING
I VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 Pnrtmrr PEE
HEAT & GAS LINE
4 PERMIT FEE
SIGN PERMIT
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
FEB
a AMOUNT DUE
ATTENTION
THIS PEMFIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1101
I'l
[:] No
k�l -) I
I I L
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.
FIR—ECTOR'S SIGN7AT1UJR1E____
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