640128.pdfMIN
PLAN FILM NUMBER
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PERMIT 128
640
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BER
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SIDE YARD
SET ACK REAR YARD
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MAP NUMBER VACANT SITE
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0 YES NO
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4
BUILDING AREA.
LOT AREA IiCE NUMBER
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ALL BUILDING SETBACKS
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NOTE: TO EAVE LINES
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Encron,c men
T OlLaUE CHECK
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Required
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YES 0 NO
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E I SERVICE SIZ C LEE A C CHECKED By
29T XSIZ E RA.N E
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TYPE CONNECTION
VERIFIED BY
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WORK
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B"ILD' NO
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I I VALUATION
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8 DING PERMIT
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NUMBER OF STOWUlE8
DEMOLISH
2 _E
2 FEE
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PLUMBING
FDEMOLJTION
NEW
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3 PERMIT FEE
ADD
AT & GAS LINE
"EAT & GAS LINE
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ALTER
RESIDENTIAL NUMBER OF
4 PERMIT FEE
4 MIT FEE
Pf]R JIT FEE
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REPAIR
DWELLING
NON-RESIDENTIAL UNITS
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5 P MIT Eb
5 PERMIT FEE
61 A?,IOUNT DUE
I hereby acknowleAge that I have read this application; that the In* ATTENTION
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 PER511T
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation insurance. WORK NOTED
NOTE: PERMIT LIMIT ON 'YEAR INSPECTION
T (0 NER R ENT) D�ATE S NFD PARTMENT
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CITY OF
"T PLAN CHECK & APP��I) EDMONDS
PR 6-1107
FILE
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or
[] YES [:] NO
TOTAL PER 1;r
0
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0
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged in space provided.
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