640302.pdfHE PLAN FILE NUMBER BUILDING
PERMIT
Applicant Fill NUM13ER 640302
k1ding Permit Applicatint, I Inside Heavy LlneS I
NAME UF BUSINESS) JOB ADDRESS Z7
7 19
DR 88 YARD SET BACK REAR YARD
T SITE
YES [3 NO a
BUILDING AltNA LOT AREA VARIANCE NUMBER
HEIGHT ALL BUILDING SETBAC' 9
NOTE: TO EAVE LINES
ELEPHONE NUALSFIR REMARKS
ca=
Encroac-hment, Permit sTREEr oR&DE CHECK 6
Z
Required
n
F 8 NO
00—NE NUMBER SIZE SERVICE SIZE CLEARANCE CHECKEDBY
METER
2 -7 7-
BE NUMBER CITY I ICENSE NUMISN't Ims
BIA
.1 76T,,� L L a c-
TYPE CONNECTION
fi-cc, C, r? D IV rd 121 17-T—.- ER
PERO. TEST
e c A/
E ITY STRUdTTON STREET IMPROVED
11 A4 TS .-e-1 I [j YES NO
SPECIAL INSPECTOR RE�Qulkmjj '-OCCUPANCY GROUP
[3 YES NO
PUAN CHECKED 13Y
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WORK TO BE DO
FL C) R - o�� C e- r-) -t� tv T
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
I
NEW DEMOLISH
—NUMBER OF STORIE
PLUMBING
ADD
3
PERMIT FEE
...
HEAT & GAS LINE
ALTER J-71 RESIDENTIAL
I
NUMBER OF
4
PERMIT FEE
DEMOLITION
PERMIT FEE
REPAIR NON-RESIDENTIAL
DWELLING
I UNITS 5
PROPOSED USE
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
formation given to correct'. and that I am the owner, or the duty author-
ized 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
SIGNATU .(OWNER OR GE SIGNED
INSPECTION
DEPARTMENT
&t, /� - 196-
CITY OF
Ij
EDMONDS
L PLAN CHECK & APPROVED
PR 6.1107
F71LE
00'"
1 1 5, C5�-v 1
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.