23753 76TH AVE W (3).pdfPLAN
licant Fill
Permit Appi Lines
FILE NUMBER
ul"Ulau Z/
PERMIT
NUMBER
�,,,Building
�Pjjeavy
(OR NAME OF BUSINESS)
JOB
ADDRESS
�741, �6/ AV.
.,,:X.AILING ADDREBS_
SIDE
YAjtD
SET BACK REAA
1;�
As
W&J�zMONff--NUMBLkL
U87ENE
MAP NUMBER VACAN ' T SITE
0
S)
0 NO
Z
BUILDING
LOT -AREA VARIANCE NUMBER
11
D
NAME
EIGHT
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
NEW
TUE ONE NUMBER REMARKS
c,2
NAME
D
as
Encroachment
Permit
PERMIT NUMBER STREET GRADE CHECK
Requirei
Y a
Y
TELEPHONE NUMBER -
METER SIZE SERVICE SIZE CLEA RANCV CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMA 8
LOT TRACT
4
TYPE CONNECTION
VERIFIED BY
PERO. TEST PERMIT ITI—M—BER,
NEW
DEMOLISH
:1 ADD
1 02,
D
ALTER
RESIDENTIAL
NUMBER OF
I
DWELLING
I
REPAIR
NON-RESIDENTIAL
UNITS
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 -
[zed 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.
NOTE: PERMIT LIMIT ONE YEAR
CHECK &
FILE
[] YES
I
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
-51
DEMOLITION
PERMIT FEE
a I AMOUNT DUE
I [] YES 0 NO
ICY GROUP
TOTAL Fes
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
I receipt is aclmowledged in space provided.
INSPECTION DIRECTOR'S §I ATURE
DEPARTMENT
CITY OF DATE
EDMONDS
PR 6-1107