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PLAN FILE fqUMBER
1JUILiOLNG
640268
Building Permit Application
Applicant Fill
Inside He, Lines
PERMIT
NUMBER 'q A 'I
NAME, tUn VAAIM U0 MUS114NUS)
t
SIDE YARD
SEW ASACK REAR YARD
24 S W,
M�PHONE NUMBER
C�Tjp
USE ZONE
WAr xquMRER VACANT bl'I'Z
AA 41109
0 YES NO
a
NAME
BUILDING tEA
LOT AREA VARIANCE NUMBER
HEIGHT
ALL BUILDING SETBACKS
Ik
NOTE: TO EAVE LINES
TELEPHONE NUMBER
REMARKS
NAME
04
AD BESS
Encroachment Permit
NU��kt STREET GRADE CHECKI
Required
Z
r I NO
CITY
TELEPHONE
METER SIZE 1 SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER REMKRK13
LOT BLOCK TRACT
TYPE CONNECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION
SPECLILL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES 0 NO
PLAN CHECKED BY
7
NO. OF 13LDG9. PERJBLDG.. TOTAL FEE
Z
BUILDING
1 VALUATION
BUILDING PERMIT
NEW I El DEMOLISH NUMBER OPSTORIE
2 FEE
PLUMBING
00
ADD 0
3 PERMIT FEE 10—eo 0
��r
HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF
4 PERMIT FEE
DWELLING
REPAIR FV1 NON-RESIDENTIAL UNITS
1,1.�j 1
DEMOLITION
5 PERMIT FEE
-FR-OPOSED USE
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given Is correct; End 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 PERMIT
This application is not a permit until
lating c0astructl0n; 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 WorkmerVa Compensation Insurance.
WORK NOTED
.1
receipt is aclmowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
DIRECXGR;"IGNATURE
RE (OW OR Olt AGENT) DATE SIGNED INSPECTION
4"o
DEPARTMENT
CITY OF
DATE ov
Z
LOT PLAN CHECK & APPROVED
EDMONDS
PR 0-1107
FILE