640293.pdf1i
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Permit
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Applicant Fill
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That ptn of Govt Lot 4, Sec 18, T27N9
R4E. W.M.9 ijegnys ns fn1inwso Beg nt th
SW cor of Govt lot 4, th N 00501 E 201;
th W 201 to POE; th N 00501 E 77,381;
th W 168.141; th S to No margin of 196
St. SW; th S 8903912011 E along said n1
street margin to POB. As situated in
Sno. Cty, Wash -
WORK TO BE DONE
Required
F1 YES
METIMY
4;/,-- 1
E] YES
NUMBER
PERMIT
640293
NUMBER
s/,F
7,
SET BACK
REAR YARD
7L—
MAP NUMBER
DR-,
VACANT SITE
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1,k6ms 13 NO
LREA
LOT AREA
VA RIANCE NUMBER
,773->� /& -7
ALL BUILDING SETBACKS
NOTE:
TO
EAVEI LINES
NO
x
0 NO
BUILDING
VALUATION
BUILDING PERMIT
I
FEE
E1_NnW
DEMOLISH
NUMBER OF STOY�Es
PLUMBING
El ADD
3
PERMIT FEE
—
4
HEAT & GAS LINE
PERMIT FEE
MALTER
RESIDENTIAL
NUMBER OF
El REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
PRO BED USE
t/ / ZV_
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author.
ATTENTION
ized agAint of the owner. I agree to comply with city and state laws regu-
THIS PE113UT
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
4 DATE SIGNED
SIGNATU (OWNER On GENT) Y`7-6�11
�T
INSPECTION
DEPARTMENT
CITY OF
PLOT PLAN C�K
EDMONDS
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PR 0-1107
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[] YES 0 No
)F OLDGG. PERIBLOG. TOTAL FEE
I I A 7 el U I
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspe.c-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
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