640112.pdfr
�LAN FILE NUMBER
BUILDING
A ppucant Fill
Building Permit pplicationi Inside Heavy Lines
PERMIT
-
NUMBER
I�UIIIBER
NAME (OHPAN� Vx �USINESS)
JOB ADDRERS
Cd
'126
MAILING ADDIMbel
S E AR
R,EA'_RYARD
SET BACK REAR YARD
L4
-7='
CITY TELEPHONE NUMBJER
- 1
BE Z NE
j ITE
V C L7 Sit
MAP NUMBER VACANT
/FO/72A Q 0' 5 1 ple,-4, (/,-2,
S 1
/ -2-- v Ej YES 0 0
rl Y C
E 0
VARI NCE NUMBER
0
NAME
BUILDING AREA
1AY1` AREA
117
A 8
HFIGHT
ALL BUILDING SETBACKS
-L,
NOTE: TO EAVE LINES
Q
2, "A
I Y TELEPH
RE 8
v
NAM
e-
oachment Permit
PERM3.T NUMBER siMEM GRADE CHECK
DRESS
Required
Y
z
C Y TN"k'J1VNXi �UMBER
[-I
I �TER SIZE 13ERVICE SIZE CLEARANCE CHECKED BY
10�f_ — L6 �
-REMARKS
STATE Llfjt;NbZ aUWDZA� CITY LICENSE "Wkskin
LOT BLOCK TRACT
TYPE CONNECTION
VEIUMED BY
PERC. TEST
PER T NUMBER
RE ZONE TYPE OF CONSTRUCT 0 ROVED
No
?
z
_9PECIAL INSPECTOR REQUI_"NLJUUUU��rlux ... UP
0
0 YES 0 NO
PLAN CHECKED BY
WORK TO 1315 VONIS
NO. OF EILDOS. PERID TOTAL. FEZ z
BUILDING
VALUATION
4r
IRMIT
BUILDI1TG PL
2 FEE
NumijER OF STORIE
NEW HDEMOLISH
PLUMBING
ADD �1�
3 PERMIT FEE
-
- __e 07
HEAT & GAS LINE
D ALTER RESIDENTIAL NU R
4 PERMIT FEE
D=LLINGOF
REPAIR NON-RESIDENTIAL UNITS
DEMOLITION
5 PERMIT FEE
6 AMOUNT DUE
17- -EQ
IS 0,
I hereby acknowledge that I have read thin application; that the In.
ATTENTION
APPLICATION APPROVAL
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-
THIS PERMIT
This application Is not a pernlit 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
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance.
wolur NOTED
receipt Is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
BIG NT) DATE SIGN ED
INSPECTION
DEPART I%IENT
RE �;6,OIGNATURE
DI _�;201
2�
CITY OF
EDIVIONDS
DATE
OT PLAN CHECK & APPROVED
PR 6-1107
FILE
I
0
;77