640218.pdf.. . .... ... .. ..... . .... .... ...
Applicant Fill
Building Permit Application inside Heavy Lines
N FILE NUMBER
BUILIVINU
PERMIT
NUMBER 640218
NAME (OR NAME OF BUSINESS)
JOB ADDRESS
MAILING ADDRESS
SIDEAARD
SET BACK YARD
A,
(TITY wNLEPHOVE NUMBIUt
USE ZONE
MAP NUMBER VACANT SITE
Ed �,jn oj 1:�,, -2- (0 0
J_
0 YE13 0 NO
NAMM BUILDING AREA
LOT AREA
VARIANCE NUMBER
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
ICITY
TELEPHONE N 'MISER
REMARKS
M1:1.
NAM
—ADDRESS
Encroachment Perrot
Required
NUMBER STREET GRADE CHECK
I
0 Wa
It
U L'A
YES Mn
-
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKE D BY
7 �_0'7��
STATE LICENSE NUMBER
CITY LICEN13E NuMiSER
REMARKS
LOT BLOCK TRACT
TYPE CONNECTION
VERIFIED 13Y
j,
PERO. TEST
PERMIT NUMBER
6'
V
FIRE ZONE TYPE OF CONSTRUCTION STR EET IMPROVED
I
1 0 YES NO
If—' SPECIAL INSP ECTOR REQUIRED __T_0CCUPANCYX
(GROUP
e/ el
0 YES -No
PLAN
CHECKEDBY
-WORX-Ta BE DONE
NO. OF RILDGIS.
PERIBLOG..
TOTAL FEE
BUILDING
VALUATION
BUILDING PERMIT
0 t
2
FEE
F] Ew
DEMg8H
NUMBER OF STORIE —
WAED
3
PLUMBING
PERMIT FEE
Id
F
HEAT & GAS LINE
ALTER
RESIDENTIAL
NUMBER OF
4
PERMIT iEi�'
1:1 REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
1
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
ATTENTION
APPLICATION APPROVAL
formation given to correct; and that I am the owner, or the duly allthor-
Ized agent of the owner. I agree to comply with city and state laws regu-
THIS PERI%UT
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
relating to Workmen?a Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt Is acknowledged In space provided.
1) T
AGE14T) NED
SIGNATURE (O"E)R OR 1_7E IG
INSPECTION
DEPARTMENT
DIREC SIGN URE
CITY OF
DATE
no
PLOT D /Po EDMONDS
0 &APPROVE
I'll, 0-1107
X,
-7
FILE