640251.pdfLAN ILE NUMBER BUILDING
nApplicant FIR PERMIT
Building Permit Application side Heavy Line] I NUMBER b40251
N�T (OR NAME OF BUSIJUESS)
9
LIM ADDJRESS
CITY TELEPHONE NUMBLR
7
NAME
m
N1
. '�_' d i. / If '-/
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L_jj NEW DEMOLISH
El ADD
QALTER R RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
Y
I hereby acknowledge that I have read thin application; that the In-
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-
lating constrUCUOn; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
BIG ATURE (OWNER 0
RA.GENT) DAT GNED
,1OT PLAN CHECK & APPROVED
FILE
'6) �;� - -
W#11111481
.5—/,,-
LCK REAR YARD
21 1�_ I— 1 11
UMBER VACANT SITE
I [] YES [] NO
,OT AREA VARIANCE NUMBER
I _ I P�
ALL BUILDING SETBACKS
NOTE: TO EILVE LINES
Encroachment Permit PERMIT NUMBER STREET GRADE CHECK
Required
o YES NO
METER SIZE
SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTIUN
VERIFIED BY
PERO. TEST
PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STRE, T IMPROVED
1 0 YES 0 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
[3 YES [3 NO
PLAN CHECKED BY
.0
NO. OF BLOOD.
PERIBLOG.
TOTAL FEE Z
1
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIs PERMIT
This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
WORK NOTED
tion, or his deputy; and fees are paid, and
receipt Is acknowledged In space provided.
INSPECTION
DIRECTO P i?NATURE
DEPARTMENT
CITY OF
DATE
EDMONDS
PR 0-1107