640207.pdfApplicant Fill
Building Permit Application linside Heavy Lines
PERMIT
NUMBER 6402107
No.*E (OR NAMIG OF BUSINESS)
0 s-
JOB ADDRESS
MA LING ADDRESS
k)
SIDE YARD
I f
I
SET BACK
I
172
AR YARD
- I
6 5
A
� -/--
'S
CITY
TE I-JIV141a INUMBPAt
_USE ZONE
MAP NUMBER
VACANT SITE
.4")
�) z7TTI-V_4--�-
26o
e-�2
I _P�ES [j NO
NAM
BUILDING AREA
WT AREA
VARIANCE NUMBER
rl/�' Z 0 1- D K E� C -* k)
G, "-t) /--I
ADDRESS
7jl
HEIGHT
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
-rW7i,-V_ 44— UAW
77,oyll If PHONE IUMBJ
REMARKS
NAME
ADDRE1311
Encroachment Permit PERMIT NUMBER STREET GRADE CHECK
Required
0 YES 0 NO
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE BY
ICHECKED
I
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
C/oo
LOT BLOCK T�CTJj
I e"�O'
TYPE ONNECTION VER4�
�BY
7K
PERC.e,TEST
JPE7NUMBER
eal 6
TYPE OF CONSTRUCTION ST EwT IMPROVED
af ""'( q I 7YES NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
WO
YES
[]
PLAN CHECKED BY
WORK To BE DONE
NO. Or BLOGG.
PERIBLOG.
TOTAL FEK
c_-, I c A le P 0
BUILDING
VALUATION
to
2
BUILDING PERMIT
FED
NUMBER OF 13TORIEE
L__
NEW
DEMOLISH
3
3
PLUMBING
PERMIT FEE
ADD
4
4
HEAT & GAS LINE
PERMIT FEE
ElALTER
RESIDENTIAL
NUM13ER OF
M REPAIR
NON-RESII
DWELLING
UNITS
5
5
DEMOLITION
PERMIT FEE
6
6
AMOUNT DUE
in_
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-
r
Ized agent of the owner. I agree to comply with city and state Iowa regu-
THIS PERMIT
This application is not a permit unt1l
on
lating construction; and in doing the work authorized thereby, no person
In 0,
will be employed In violation of the Labor Code of the State of Washington
AUTHORIZES
ONLY THE
S Igned by the Director of Building Inspec-
relating to Workmen's Compensation insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is ac . Imowledged in space provided.
_DIRE
INSPECTION
SIGNATURE NO OR G T DATE SIGNED
R 11 A
S SIGNATURE
DEPARTMENT
e
CITY OF
DATE
4/_
EDMONDS
PR 0-1107
OT PLAN API1ROVED
7
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