640290.pdfBUILDING
PLAN FILE NUMBER
Applicant Fill
Application Inside Heavy Lines
RUSIN 5) JOB ADDRESS &.4 (n�� C;L
57
%P
SIDE YAr SET BAUM
LS
M.A VA ANT SPITE
4_1 PHONE NUMBER us ZONE YES NO 0
IVY JUU�A 6T—AREA VARIANCE NO
/0
1-1 AaG A L BUILDING SETBACKS
NOTE: TLO EAVE LINES
REMARKS
TREET GRADh;UnmvK 6
Permit
neroachment Z
Re utred
q
��e rj YES
CE CREC BY
TE -PHONE NU MET S E BE I E SIZE C A
I'lly
STATE L.LUZVM� ER RKS 03
LOT T
TYPE C NECTION VE BY 94
PER I NUMBER
PERC. TEST W
FIRM ZO TYPE OF CONSTRUCTION
I ZYE
s pro
Z SPECIAL lribr��Iu"
[] YES vl�o
PLAN CiFECKED BY
WORK TO BE DONE No. or SLOGS. PERIBLOO. TOTAL FEE
BUILDING
I VALUATION
BUILDING PERMIT 02
NUM STORIE 2 FEE
NEW DEMOLISH PLUMBING
3 PERMIT FEE
ADD
HEAT & GAS LINE
NUMBER OF 4 PERMIT FEE
El ALTER RESIDENTIAL DWELLING DEMOLITION
E] �EPAIR NON-RESIDENTIAL UNIT13 5 PERMIT FEE
PROPOS BE I 'D
6 AMOUNT DUE
I thereby nowledge that I h * vo read this application; that the In- ATTENTION APPLICATION APPROVAL
formation given Is correct; an that I am the Owner, or the duly author- n is not a permit until
ized agent of the owner. I agree to comply with city and state laws rCgU- THIS PERMIT This applicatto
AUTHORIZES
lating conctruction; and in doing the work authorized thereby, no person signed by the Director of Building Inspec
mployed In violation of the Labor Code of the State of Washington ONLY THE or his deputy; and fees are paid, and
will be c NOTED tion,
WORK ided.
relating to Workmen's Compensation Insurance- receipt is aclmowledged in space prov
NOTE: PERMIT LIMIT ONE YEAR DATE SIGNED INSPECTION DIRECTO 'S NATURE
DEPARTMENT
CITY OF DATE
in EDMONDS
PL ROVED PR 0.1101
FILE