640338.pdf4
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TELEPHONE NUMBEaR USE ZONE
BUILDING ARI
TELE PHONE NUMBER
REMARKS
Yvw
Encroachment P=
Required
rl YES M NO
1 BLOCK
9-7
BUILDING
PERMIT 640338
NUMBER
0, VU44)
.% 1�oq
PERO. TEST
FIRE TYPE
SPECIAL INSPECTOR, B
YES 340
PLAN CHECKED BY
0 WORK TO BE DONE
0
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
F1NEW
DEMOLISH
NUMBER OF STORIE13
—
PLUMBING
ADD
1,� 57ol?
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
F-I RESIDENTIAL
1 NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
—
5
DEMOLITION
PERMIT FEE
PROPOSED USE
—
_57A 0 RA,,V -7 S-7 e) &,j G,5 4 4 PAII Tell 9t
JJTS6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
ATTENTION
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
INSPECTION
DEPARTMENT
OITY OF
SIGN URE (OWNER OR AGE DA!rZ MUNkU)
EDMONDS
PH 6-1107
PLOT PLAN CHECI�C V V
j3j%1lCVED
FILE
I
VACANT SITE
0 YES 0 NO
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
If le,
IM.ED OCCUPANCI
10o OF
YES 13 NO
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2-
1 1.5 3. 0 cl) 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 acknowledged In space provided.
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