640229.pdf■
PLAN FILE NUMBER BUILDIN(
WingPermit Application Ins d ' ant Llines PERMIT
A= (OR NAME OF BUSINESS) JOB ADDRE08
^,` 6 ADDRESS ti BIDE YARD BET SACK
3 � - 7s- = A
.c� TELEPHONE NUMBER USE ZONE MAP NUMBER
IM oil cis _ �'�' (o — 3 0 I /O V Al U)
t,
. ITELEPHOR
s.: Required
0 V �- YES NO
TELEPHONE NUMBER MET R SIZE 18ERVI
LICENSENUMBER CITY LICENBIP NUMBER REh[ARKS
r yet
BLOCK (TRACT
TYPE CONNECTION
PERO, TEST
RE ZONE TYPE
x
$ SPECIAL INSPECTOR
[gi YES ❑ NO
• GC — o 11 C-�s��
BUILDING
VALUATION
1
BUILDING PERMIT
FEE
NUMBER OF STORIES 2
NEW
DEMOLISH
PLUMBING
ADD
C �
9
PERMIT FEE
-
HEAT h GAS LINE
ALTER
RESIDENTIAL
OF 4
PERMIT FEE
REPAIR
I
NON-RESIDENTIAL
(NUMBER
DWELLING
UNITS
0
DEMOLITION
1 PERMIT FEE
61 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author- ATTENTION
(zed agent of the owner. I agree to comply with city and state laws regu. THIS PERMIT
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
DATE SIGNED INSPECTION
DEPARTMENT
6 CITY OF
EDMONDS
PR 5-1107
NOTE: T LEwVD NES ETBACKe I ^ I
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged in space provided.
Dirk van Dyk, Bldg. OflMial
M