650239.pdfPLAN 17IL—ENUMBER BUILDING 65U239
Building Permit Applicat on
Applicant Fill
PERMIT
NUMBER
Inside H
7—'WA—ME(OR NAME OF BUSINESS)
JOB
XL16ADDRESS
SIDE YARD
1
BACK
1
HEAR XAIVU
010
TELEPHONE NUMBER
USE ZONE
MAP NU USER
VACANT SITE
1 [3 YES 0 NO
BUILDING AREA
LOT AREA
VARIANUB VUWzZn
HMORT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
�croaci�ment Permit PERMIT NUMBY" WrItEN'17 U��Xi 1
Required
ri YES rj NO
,B E LICENSE NUMBER CITY LICENSE NUM13ER
REBLARKS
cc
,LOT BLOCK TRACT
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
I NE YPE OF
CONSTRUCTION STREET IMPROVED
I
1 0 YES 13 NO
SPECIAL INSPN OCCUPANCY GROUP
YES 0 NO
IFLAN —CHECKED By
WORK TO BE DON
NO. Or BLOGS. PER)OLDO. TOTAL FEE
A e '�ej
BUILDING
1 VALUATION
BUILDING PERMIT
2 FEE
OA
QNEW DEMOLISH NUMBER OF STO
— PLUMBING
3 PERMIT FEE
ADD
NUMBER OF
HEAT & GAS LINE
4 PERMIT FEE
ALTER RESIDENTIAL
DWELLING
UNITS
DEMOLITION
IU NO]
5 PERMIT FEE
—PROPOSED USE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
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-
THIS PERMIT
This application is not a permit until
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
relt,ting to Workmen's Compensation Insurance.
WORK NOTED
tion, o r his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
q
------ OR AGENT) DATE
IIGZATURE (OWNER SIGNED
INSPECTION
DEPARTMENT
1ATURE
CA,
CITY OF
DATE
EDDIONDS
r.OT PLAN CHECK "PPR VED
PR 6-1107
FILE