650272.pdfI
Building Permit J
NAME (OR NAME OF BUS]
j
MA LING ADDRESS
CITY
—r
NAME
DRESS
c),
licant FIR PERMIT
lion I =BER 650272
I.Sde'Heavy Lines
f JOB ADDRESS
0 i� k) F_5 - 2- �;
SIDE YARD
f r
-7
SET BACK
REAR YARD
fj)
YV,,- 4-
TELEPHONE NUMBEIR FSE ZONE
I
MAP NUMBER
VACANT SITE
ILL)- 76SO / >�-
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I YES NO
BUILDING AREA
LOT AREA
VARIANCE NUMBER
N
ALL BUILDI 0 SETBACKS
I NOTE:
HEIGHT
TO]
NEW DEMOLISH NUMBER OF STORIES
ADD I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
I hereby acknowledge that 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 Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
PLOT PLAN CHEgX & APPROVED
FILE
Required
11 YES
[] YES
LOAM
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT i
CITY OF
EDMONDS
PR 6-1107
0 YES [] No
or ntnos.
PrRIDLDG.
TOTAL FEE
I --- 1 -5� 0-v I
APPLICATION APPROVAL
This application Is not a pernilt 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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