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Applicant Fill
n ppirmit Annfication Ua.� T.InAQ I
............ ......
MBER BUILDI
PERMIT 640 155
NUMBER
NAME (OR NAMI-3 OF BUSINESS)
JOB ADDRESS C7 47 0 -1 5L
!W__ LING ADDRESS
SIDE YARP
sEw BACK
REAR YAP
cr OE7
<:� I
/-S:-
CITX
TELEPHONE NUMBER
us ZONE
MAP NUMBER
VA ANT SITE
YES NO
NAME
BUILDING AREA
jFp-M
I LAj'i7 AREA
VARIANCE NUMBER
'rw '�j
'362 Y, / 60 0
7 &-o-tz -,A— I
l.
ADDRESS
HEIGHT
I BUILDING SETBACKS
NOTE:
P4
Ila
TO EAVE LINES
TELEPHONE NUMBER
REMkRKS
NAME
7 �DREIIS lao-6 A7-P747'VC-
Encroachment Permit
PERUIT NUMBER
STIW RADE CHECK
Required
Z
0 YES
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE
ICH
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
TYPE CONNE N
VERIPI
09
4
PERC. T EST
PERMIT
�D7ER
TYPr
-
OF CONSTRUCTION T IMPROVED
0 1 ; 7YE S [3 NO
-SPECIAL INSPECTOR REQUIRED
;eo,
OCCUkA.N(;X UnU
YES
PLAN
CHECKED BY
WORK TO BE DONE
NO. OF SLOGS.
PER/8LOG..
TOTAL IrSE
BUILDING
1
VALUATION
N
2
BUILDING PERMIT
FEE
AD
ZNEW
DEMOLISH
NUMBER OF STORI
PLUMBING
k' 4
3
PERMIT FEE
0 ADD
1
HEAT & GAS LINE
io
N I
—
ALTER
RESIDENTIAL
NUMBER OF
4
PERMIT FEE
DEMOLITION
E]
DWELLING (2
UNITS <f
REPAIR
NON-RESIDENTIAL
5
PERMIT FEE
PROPOSED USE
AMOUNT DUE
I hereby acknowledge that I have read this 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-
Tins 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
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance.
'*VoRK NOTED
receipt Is acknowledged in space provided.
NOTE: P RMIT Ll ONE YEAR
Jjn�NER 0 AG NT) DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTpa)"JGNATURE
CITY . OF
rE
EDMONDS
PL PPROVED
Pit U-1107
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