640110.pdfN FILE NUMBER
ksu LILIMU
Building Permit pplication Tof
PERMIT Ifinta=
NUMBER
H'e-avy'Nin c s
NAME (OR NA.ME OF BUSINESS)
JOB ADDRESS
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MA LING ADPRESS
SIDE YARD
SET BACK
REAR YARD
Ss— V ZJ
CITY TELEPHONE NUMBER
USE ZONE
MAV NUAIISNK
VACANT SITE
:2714—t U cis
0 YES 13 NO
NAME
BUILDING AREA
LOT AREA
VARIANCE 14UUbNkC
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
ow
Z/
TO EAVE LINES
CITY TELEPHONE NUMBER
REM -ARKS
NAME
pf e.
ADDRESS
Encroachment Permit FERMI NUMBER STREET GRADE CIIECR
Required
I I
�w
n YES NO
N
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK CT
q -.j. 3 X
001,
TYPE CONNECTION VERIFIED BY
PERC. TEST FERMT NUMBER
FIRE ZONE IUCTION STREET IMPROVED
C_
I [] YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
F-e C* C. IZ
YES [3 NO
PLAN CHECKED BY
WORK TO BE DONE
NO. OF ULDGS.
PERIPLOO.
TOTAL FEE
1
BUILDING
VALUATION
2
BUILDING PERMIT/F
FEE
NUMBER OF STO 8
NEW
DEMOLISH
PLUMBING
3
PERMIT FEE
ADD
4
HEAT & GAS LINE
PERMIT FEE
Fk�YIRESIDENTIXL
NUMBER OF
ALTER
DWELLING
UNITS
DEMOLITION
REPAIR
NON-RESIDENTIAL
5
PERMIT FEE
6
AMOUNT DUE
I hereby acknowledge that 1-have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given Is correct: and that I am the owner, or the duly author-
lzed 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
relating to Workmen's Compensation Insurance. WORK NOTED
tion, Or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
WI—GNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DIRECTOR'S SIG;kTU
DEPARTMENT
� — _6 /
Dirk van Dy
;;M
2_�—
CITY OF
DATE
EDMONDS
ej_pj!2j�Pr_AN CH�7 & APPROVED X Pit 6-1107
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FILE