660300.pdf4NG DEPARTMEN
AIT APPLICATION
Men
aA A f e
• POSTED ON KROLL MAP No. PERMIT G 660300
Applicant F111��
Inside Heavy Lines JOB ADDREsa
FRS d �- 7� '
SIDE YARD SETBACK STREET SETBACK (REAR YARD SETBACK
J -y�\p^I..,, /� I LOT AREA I VACANT SITE
t LC/ . V v ❑ YES NO O
TELEPHONE NUMBER
P i?I r J e �6 6 HEIGHT -----..-^I BUII.DINO AREA I VARIANCE NDl[BER
CITY LICENSE NUMB
low or Attach Four (:ogles)
is. 34 ,col ,
— Plc % o-
❑ N 0W � U SIGN
❑ ADD DEMOLISHEl
FENCE
�^ ALTER I RESIDENTIAL I DWELLINOF
1 1 REPAIR NON-RESIDENTIAL UNITE
I hereby acknowledge that I have read this application; that the In-
formation given In 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 Washington
relating to Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year he completed In ninety days.)
!I� URE (OWNER DATE SI N/ED
NOTE: APplicant SuVect to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction n�� eic.) will rtthe public gWre eparaten (curbs, sP rmleslondrhrowaYe,
I3UH.DING
I VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT A GAB LINE
4 PERMIT FEE
SIGN PERMIT
5 FEE
DEMOLITION
d PERMIT FEE
PLAN CHECK
7 FEE
g AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
■ ■
�L 4131 546
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.
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