700099.pdf-----------
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PERMIT
BUILDING DEPARTMENT Applicant FlU NUMBER 650420
PERMIT APPLICATION Inside Heavy Lines _0H ADDRESS 7/'7
NAME (ou NAxx; OF BUSINESS)
ARD SrTBACK 13TREEir SEIBACK REAR YARD IJETBACK
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MAILING "WINUb
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USE ,,WNE
LUT AREA
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CITY
TELE PHONE NUMBER
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0 YE13
0
HEIGHT
BUILDING AREA VARIANCE NUMBER
APPROVED
NAME
ADDREM
94
CITY
TELEPHONE NUALUM"
REMARKS
03
ADDRESS
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METER SIZE SERVICE
SIZE CLEARANCE CRECKED BY
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CITY or
rELEPHONE NUMBER
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STATE 1AUNINOW Dlu=m�-u
CITY LICENSE 14U.-M"
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TYPE CONNECTION
BY
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Legal Description of Property (Show below 0j_—Attach
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PERMIT NI JMHER'_�
SPECIAL INSPECTOR EQUIRED
0 YES Qf �O
PLAN CHECKED BY
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BUILDING
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BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE
0
HEAT & GAS LINE
4
PERMIT FEE
Q
NEW
[:3 SIGN
11
NUMBER OF STORIES
SIGN PERMIT
0 FENCE
5
FEE
rj�-�ADD
DEMOLISH
6
DEMOLITION
PERMIT FEE
_2___ALTER
Ln RESIDEN! rIAL
NUMBER OF
DWELLING
UNITS
7
PLAN CHECK
REPAIR
NON-RESI
FEE
I�RGPOSED USE
&A,-4-4E: 1240
8
AMOUNT DUE
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I hereby acknowledge that I have read thin application; that the In-
ATTENTION
formation given is correct: and that I am the owner, or the duly allthOr-
Ized agent of the owner. I agree to comply with city and state laws regu-
THIS PER511T
I&ting 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
relaung to Workmen's Compensation Insurance.
WORK NOTED
y Ncept Demolitions which shall
,0,5 l.
NOTE: Pyrnit Ljnit One be completed in ninety days.)
__
SIGyA3ZFJ DA E 8 GNED
INSPECTION
DEPARTMENT
0// 9, 747' ="WONW—
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cbeck Fec
PR 6-1107
This Permit covers work to po done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
0 YES [3 NO
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to C2
APPLICATION APPROVAL
This application is not a pernitt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
DIRECTOR'S SIONATUR1,7
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