640168.pdfAN FILE NUMBER BUILDING
Applicant Fill PERMIT
I NUMBER
,0611ding Permit Application I Inside Heavy Lines 640168
'NAME (OR NAME SINE13 JOB ADDRESS
A2 0 -2,
SET BACK REAR Y�
ILING ADDRESS SIDE YAAD
MBIaa USE ZONE VACANT
=Ty
0 YES .$(NO 0
VARIANOW INUM"Zn
BUILDING AREA AREA A4
EIGHT
DRESS ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
ITY TELEPHO REMARKS
N
94 ADDRESS Encroachment Permit MIT NUMBEIt GRADE CHECK
Z
Required NO -7CKED By
I Y -;FE—LEPHONE NUMBER METER SIZ13 SERVICE SIZE CLEARANCE
CITY LI ENSE NUMBER
LOT T-6r C- TW
17
TYPE CORN—ECTION VERIMFIE By
ERC. T PERMIT NUMBER
EST U0
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
F]YES NO
PLAN CNECKED By
Q wo LK TO BE DONE
NOm OF BLOGSo PERIBLDG. TOTAL FIEK
BUILDING
�4.
VALUATION
A BUILDING PERMIT
2 FEE
L? �it STORIIE ow
K71 I NUM13ER OF —
V�j NEW El DEMOLISH PLUMBING
3 PERMIT FEE
ADD
HEAT & GAS LINE
NUMBER OF 4 PERMIT FEE
ALTER RESIDENTIAL DWELLING j
DEMOLITION
E] REPAIR �Sk NoN-RESIDENTIAL UNITS 5 PERMIT FEE
PROPUBNO uu�
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that th In. ATTENTION APPLICATION APPROVAL
formation given to correct: and that I am the owner, or the duly au or-
tzed agent of the owner. I agree to comply with city and state laws regu- Tins rERMIT This application is not a permit until
luting construCti0a; and In doing the work authorized thereby, no person AUTHORIZES signed by the Director of Building Inspec-
e of the State of Washington ONLY THE
will be employed In violation of the Labor Cod tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance. WORK NOTED
receipt is acknowledged In space provided.
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION DI CTOR S I)IGIATURE
-jj7j9P;Cj:0xRE-�0WNWR OR —AGENT) DATN SIGNED DEPART3,IENT ddg. official
Dirt -
CITY OF
DATE
EDAIONDS
PL N CH APPROLVED
PR 6.1107
FILE