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BUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION Inside Heavy Lines I
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POSTED ON KROLL MA_
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PETU11T 670
1 NUMBER 041
JOB —ADDRESS �1171%0^0
(11 66.1 �1_
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NAME (OR NAME OF BUSINESS)
SIDE YARD SETBACK
STREET' SETBACK
REAR YARD SETBACK
UAILING ADDRESS
3
USE ZONE
LOT AREA
VACANT SITE
O'YEB 0 NO
CITY
wEl"PHONE NUMBER
HEIGHT
BUILDING AREA
VARIANCE NUMBER
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PLOT PLAN APPRPVED
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ADDRESS
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�PITY TELEPHONE NUMBER
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REMARKS
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ADDRESS
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METER SIZE SERVICE SIZE CLEARANCE _A=I) BY
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CITY
TELEPHONE 14UMB M,
—LICENSE
STATE LICENSE NUMBER
—CITY NUMBER
TYPE CONNECTION VERW BY
I
Legal Description of Property (Show Below or Attach Four Copies)
PERO. TEST PERM]IT. X
"rER
PIRr. 91.17INVI I TYPE OF CONSTRUCTION I STREET IMPROVED
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NEW E]
ADD I DEMOL
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SIGN
FENCE
L—i ALTER RESIDENTIAL NUMBER OF
DWELLING
FREPAIR 1-1 NON-RESIDENTIAL UNITS
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I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I arn the owner, or the duly author-
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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety clays.)
17,
N`0!;,�. Applicant �Kbjrrt to Plan Check Fee
This Penilit ecavers, wark to lie done (in private property ONLY.
Any construction oat the public domain (curbs, hidewall4m. drivei%aym,
marqueeic. etc.) will require neparittv pernilssitin.
El YES
[:] YES
6-N-0
BUILDING
VALUATION
BUILDING PERM T
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PER7611T
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FEE
DEMOLITION
6
PERMIT rim
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
ID 4
M
ATTENTION I APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt Is aclmowledged in space provided.
INSPECTION --61—RECTOWS
DEPARTMENT
CITY OF
EDMONDS DAT4V
I'll 0-1107
FILE
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