640166.pdfPLAN FILE NUMBER BUILDING
Applicant Fill PERMIT
Building Permit App ication linside NUMBER 640166
Heavy Lines
I OF BUSINESS)
NA P (OR NAME,
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JOB ADDRESS
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)-1-1771
fMAILING'ADDRESS,
SIDE YjRD
SET BAC X,
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�7
CITY ONE, NUMBF;a
USE ZONE
MAP NUMBER
VACANT SIT"
PT4, 7/0
- /
1 [3 NO
NAME
_57*
BUILDING AREA
LOT AREA
VARIANCE NUMBER
7
ADDRESS
HEIGHT
ALL BUILDING
I NOTE:
SETBACKS
N
TO EAVE LINES
CITY
UMBEE
TE �PHONE�N ZR_
REMARKS
NAM
ADDRESS
Encroach PFRMTT NUMPR TREE CHECK
ment F
Required
N
L
YES N70
CITY
TELEMONE NUMBER
METER SIZE SERVICE SME-1 CLEARANCE CHWD BY
I
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
7' 7 P, q
TYPE ONNECTION V D BY
e— e_.1
PERC�/ITEST I FIR117 NUMBER
FIRE ZONE TYPE OF CONSTRU*ON STREET IMPROVED
YES [I ITO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES NO
0
PLAN CHECKED BY
WORK TO HE DONE
No. OF BLOOG.
PERIBLOG.
TOTAL FCC
Z
BUILDING
A4 6-tl /1?11 e /'d e -7,1
0
6
VALUATION
2
BUILDING PERMIT
FEE
NEW
n D13MOLISH
NUMBER OF STORIES
I
3
PLUMBING
PERMIT PEE
ADD
—
4
HEAT & GAS LINE
0--V
ALTER
RESIDENTIAL
NUMBER OF
PERMIT FEE
DWELLING
UNITS
DEMOLITION
REPAIR
NON-RESIDENTIAL
5
PERMIT FEE
6
AMOUNT DUE
v
I hereby acknowledge that I have read this application; that the in-
ATTENT]ION
APPLICATION APPROVAL
formation given to 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 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 vlolRtl0a Of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
receipt is aclmowledged In space provided.
NOTE: PERMIT LIMIT ONE YEAR
SIGNA RE R —1 DATE SIGNED
INSPECTION
RES;09!r S)GNATURE
DEPARTMENT
Fe
--6
CITY OF
��C�c
'I
EDIVIONDS
DATE
L N & APPROVED
Pit 6-1107
. ............