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640148
PLAN FILE NUMBER
BUILDING
Building Permit App icationi I s'l dPeP'Hl ceaanvty 12111 c 9
PERMIT
1 NUMBER
NAME (OR NAME OF BUBINNUH)
4 YN A,'.',, J 0 0 D /3t] AZ _S
MAILING ADDRESS
CITY rELEPHONF NUMBLA
JOB ADDRESS
/
SIDE YARD
/
SET BACK REAlt YAIW
7—
MAI NUM13ER VACANT BITE
/, �114 /V
NAME
BUILDING AltNA
1-,-2' 0 lv��— I 1;�,YES [] NO
LOT AREA VARIANCE NUMBER
I I e)l -,7,f
0
ADDRESS
HEIGHT
BUILDING SETBACKS
I NOTE: ATLLEAVE LINES
Aw
CITY
TELEPHONE NUMBER
NAM
Q�Ess /3 or= S
roachment Fermi
Required
PERMIT NUMBER STREET GRADE CHIECXI_
I
,'4 1A
rIYES 0 NO
CITY
TELEPHONE NUMBEuR
METER SIZE SERVICE SIZE CLEARANCE CHE
Y
-541 5/4-
I
I
STATE LICENSE NUMBER
NUMBER R RKS
LOT BLOCK TRACT
44RA5P-7 CL
g_= LI,/ A DPAJ
TYPE NNECTION
I I _.
VERIFIED BY
PERC. iWEU'17
PERMIT NUMBER
7 �
RN ZONE PE OF CONSTRUCTION STRE�ET IMPROVED
I
1 0 YES [3 I -TO
Z
0
SPECIAL INSPE REQUIRED
[] YES brNRO
OCCUPANCY GROUP
PLAN
CHECKED BY
0
0
ft
Go
WORK TO BE DONE
NO. Or BLOGS.
PERIBLOG.
TOTAL FEZ
BUILDING
VALUATION
ffU�
1
2
BUILDING PERMIT
FEE
3 L
NEW
ADD
DEMOLI SH
NUMBER OF STORIE —
3
_�LUMBING
PERMIT FEE
&V
HEAT & GAS LINE
PERMIT FEE
Q ALTER
REPAIR
Lind RESIDENTIAL
NON-RESIDENTIAL
DUMBER OF 4
WE
'LLING
UNITS 5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
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-
ATTENTION
APPLICATION APPROVAL
ized agent of the owner. I agree to comply with city End 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
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
This application Is not a perTait until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
SIGN WR AGE�� IGNED
214/ 1"/ 3 h
Pi.iYr PLKIN C APPRO94,
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
I
DIRECTOR IGNATURE
e.
PR 0.1107
FILE
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