660504.pdfPOSTED ON KROLL ?.TAP NO.:,
BUILDING
BUILDING DEPARTMINT Applicant F ill
I PERMIT
660504
NUMBER
Inside Heavy Lines
PERMIT APPLH
JOB ADDRESS
1196-IV-79
NAME (OR NAME OF BUSINESS)
SIDE YAR SETBACK
STREET SETBACK
YARD / SET BACK
MAILING ADDRFS13
IREAR
1.5-
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USE ZONE
LOT AREA
VACANT SITE
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CITY
TELEPHONE NUMBILIR
YES -fieNO
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HEIGHT
BUILDING AREA
VARIANCE NUMBER
NAME
PLOT PLAN APPROVED
ADDRESS
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REMARKS
CITY
TELEPHONE NUMBER
NAME
REMARKS
ADDRESS
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METER SIZE SERVICE
SIZE CLEARANCE CHECKED BY
CITY
TjuLEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION
VERII-'UED BY
Legal Description of Property (Show Below or Attach Four Copies)
1-OT
PERO. TEST
PERM -IT NUMBER
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FIRE ZONE - I TYPE OF CONSTRUCTION I STREET IMPROVED
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NEW
ADD
ALTER
FREPAIR
El
DEMOLISH
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SIGN
PENCE I I
RESIDENTIAL NUMBER OF
DWELLING
NON-RESIDENTIAL 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-
fted 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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
NOTE: Applicant Subject to Plim C/lech Fee
Thin Permit eovvrs "ork to Ift, done on privale property ONLY.
Any conmtrurtlon on Ott- public donutin (curbs. hidewall4m, drivewaym,
tuarquers. i-tv.) will require separate permission.
I I El YES 0 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
I] YES 0 NO
PLAN CHECKED BY
VALUATION
TOTAL FEE
BUILDING
VALUATION
//D
V
0
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2
BUILDING PERMIT
FEE
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PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
FEE
8
AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIN PERIMIT This application Is not a permit until
AUTHORIZES
ONLY THE signed by the Director of Building Inspec-
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION 'N
3
DEPARTMENT
CITY OF
DATE
EDMONDS
PR 0-1107
FILE
.77
77
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