640212.pdfn Applicant Fill
Building Permit Applicatio Inside Heavy Lines
PLAN FILE NUMBER BUILDING
PERMIT 640212
I NUMBER
(OR NAME Ulf BUSINUSS)
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MAILING ADDRESS
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CITY TE�MONE NUMBER
USE ZONE MAP NUMBER VA—CANTSITE
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NAME
BUILDING AREA LOT AREA VARIANCE NUAIlMn
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ADDRESS
HEIGHT
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ALL BUILDING SETBACKS
NOTE: LINES
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Encroachment Permit PERMIT NUMBER STREET GRADE CHECKJ�
Required ;e
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0 YES r, No
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TELEPHONE NUMBER
METER SIZE SERM E SIZE CLEARANCE CREC BY
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STATE LICENSE NUMBER
Of MBER
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LOT BLOCK TRACT
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-I ZONE TYPE OF CONSTRUCTION STRXEw IMPROVED
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SPECIAL INSPECTOR REQUIRED
66CUPANCY GROUP
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0 YES
PLAN
CHECKED BY
WORK TO BE DONE
NO. OF BLDGR..
PER1131.00.
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BUILDING
VALUATION
V
BUILDING PERMIT
2
FEE
NEW
DEMOLISH
NUMBER OF STORIE
3
PLUMBING
PERMIT FEE
ADD
4
HEAT & GAS LINE
PERMIT FEE
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NUMBER OF
ALTER
REPAIR
RESIDENTIAL
11 NON-RESII
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
PROPO:;��_
6
AMOUNT DUE
0
I hereby acknowledge that I hafe read this application; that the In- ATTENTION
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 PER511T
This application Is not a perntit until
litting 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. WORK NOTED
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
-S—IGNATURE (OWNER OR,OENT) DATE SIGNED INSPECTION
DIRECTORIOISIGNATURE
DEPARTMENT
CITY OF
DATE
EDMONDS
(yr-MAN & APPROVED
PR 6.1107
FILE
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