640307.pdfb
Wing Permit Ap;
&ME (OR NAME OF BUSINE13
DRESS
VNI
- MW
f
PLAN FILE NUMBER
lication
Applicant FIR
Inside Heavy Lines
JOB ADDRESS
SITO
SIDE YARD
SET BACjr/
T.
, 1 4-
1_%
/,A "
TELEPHONE NUMBER
USE 7'
MAP NUMB
CdAIST
L_j NEW DEMOLISH
12 ADD I
FjALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL I UNITS
PROPOSED USE
I hereby acknowledge f9t I have read this application; that the In-
formation given is 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 CompenaLtion Insurance.
NOTE: PERMIT LIMIT ONE YEAR
UGNATURE (OWNER OR AGENT) DATESIGNED
7
FILE
BUILDING
PERMIT
NUMBER 640307
AR YARD
IRE
VACANT SITE
0 YES [] NO
VARIANCE NUMBER
ALL BUILDING SETBACKS Pk
NOTE: TO EAVE LINES
Required
Z
rl YES rl �IPQ
[j YES [] NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
e
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK INOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PH 0-1107
[] YES 0 NO
NOe OF' 81*006* PtIRIBLOG.
I /,!9V,0V
TOTAL FXE
Z
9W
1 1 -.5-7 e";-V I
APPLICATION APPROVAL
This application is not a pern-dt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
1___?
DIRECTOR%FBI ATURE
DATE
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