640344.pdf11 �
JMBER BUILDING
PERMIT 640344
Building Permit Application �nS`1ll`eP'Hceaanv'yT'1nes NUMBER
I N�_W NAME OF BUSIPFPSS)
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(OR JOB ADDRESS
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WORK T(
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NEW
ADD
ALTER
REPAIR
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PHONE NUM14BYaR[USE ZONE
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BUILDING
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Required
1`1 YES
-21
0 YES
1
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
DEMOLISH
NUMBER OF STORIES
3
PLUMBING
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
5
DEMOLITION
PERMIT I=
6
AMOUNT DUE
I I hereby acknowledge that I have read this application; that the In-
AT=NTION
formation given is correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
THIS PERBUT
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 Workman's Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
3IGN TURE WYMMn un
DATES NED,
7
INSPECTION
DEPARTMENT
UZ74L
7
CITY OF
EDMONDS
LOT pLA7XC 7APPROVED
PR 6-1107
'00 0#�
41A�
t" NUMBER VACANT SITE
3 0 YES �)<No 0
.OT AREA VARIANCE NUMBER
t13 0`0
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
cv Gz-Lv-jL/
IERMTT NUMBER STREET GRADE CHECK
UZE ICLEARANCE I CHECE=MD
4
VERIFIED
PERMIT NUMB Im
CONSTRUCTION STREET IMPI-7toVED
I ff_;�s E] No
JUIRED
OCCUPANCY ;VO P
40. Or BLOCS. PERIBLOG. TOTAL FIC
3 V/0
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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