640131.pdfI Applicant Fill
io Permit Anolication Inside Heavv Lines
60
SIDE YARD
7
TEL&P-HONE NUMBXR
USE ZONE
"/00 C/ 17f3-3 703
S
BUILDING AREA
HEIGHT
TNIMPHONE NUMBER
MARX
RE 8
Encroachment Permit
Required
YES 0 NO
W.77
TELEPHONE NUMBER
MET SIZE SERVI4
ON -LICENSE NUMBER
C17Y LICENSE NUMBER
MARKS
T CT
T E CONNECTION
r
PERO. TEST
7
RE ZONE
PECIAL INSPECTOK
S Sr.
0 0 YES E3 NO
1(
PERMIT
NUMBER
- — �� 47z(
AWL
640131
Le.
11 YARD
0 NO
s-0,
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
E] YES 13 No
WORK TO BE DONE
NO. or BLOCS. PERMLOG. TOTAL FKK
BUILDING a 0
1 VALUATION
C�75-7-,ez/cl- 1,16 4(l 11,C7,Wr- f/1,0;71 'Cr,�ojzt' r;" BUILDING PERMIT do,,)
Ful NUMBER OF STOYRUI 2 FEE. _S�o I
1,,AJ NEW DEMOLISH PLUMBING "-7D
ADD 3 PERMIT I= 17,0
HEAT & GAS LINE V_
RA NUMBER OF 4 PERMIT FEE J-0
ALTER J!aj RESIDENTIAL DWEL72NG
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
5 PERMIT FEE
6 AMOUNT DUE 0
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am tho owner, or the duly author- ATTENTION APPLICATION APPROVAL
ized agent of the owner. I agree to comply with city and state lawn 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!X Compensation Innurance. WORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR INSPECTION receipt Is aclmowledged in space provided.
3IGNATURE (0 R OR AGENT) DIRECTqXS'SIGNATURE
DEPARTMENT
CITY OF DATE
EDMONDS
LOTIPU&N y APPROVED <Z_' �_ 6
/ "I PH 6-1107 #
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