660506.pdfr
. DEPARTMENT
APPLICATION
AB-DIUW
011'r
Applicant FIB
Inside Heavy Lines
NA ED WD
SIGN
I
D E M[:O]L I S H
FENCE
ALTER
RESIDENTIAL
NUMBER OF
I
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the in-
formation given in correct; and that I aim 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 Washington
relating to Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be Completed lit ninety days.)
1IGNATURE (OWNER OR AGENT) DATE SIGN9D
�� k lljolcz�—_IL
NOTE: Applicant Subject to Plan Cbeck Fee
This Permit covers work to be done on private Promrly ONLY.
Any constructlon an the Public domain (curtim. x1dewulks, driveways,
marquees, etc.) will require separate perniiintion.
'UMTEL) ON KROLL MAP 140.:
DB ADDRESS 14,g
,_2 0 i�- -
51 1 .1 a
;ONE LOT AREA
[I YES [3 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
FEE
8 1 AMOUNT DUE
ATTENTION
THIR PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER
660506
REAR YARD SETBA
13ACK
(3 YES 13 NO a
VARIANCE NUMBER 11
YES 0 NO
_0
0 'D
1 1 3. o P, I I
APPLICATION APPROVAL
This application is not a pernift until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
FILE
I