640357.pdfI"
PLAN FILM NUMBER
BUILDING
Applicalst Fill
Building Permit Application nside Hea Lines
PERMIT
NUMBER 640357
NAME (OR NAME ub'BUSINESS)
JOB ADDRESS
SIDE YARD
SET BACK
ROAR YARD
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13 T%EPHONE NUMBER—
USE ZONE
MAP INUAWNU
�ACANT SITE
0 YES N3�NO
NAME
BUILDIRG AREA
LOT AREA
rARIANCE NUMBER
ADDRESS
HEIGHT
L BUILDING SETBACKS
NOTE:
TO EAVE LINES
CITY
LEPHONE NUMBER
REMARKS
1
-7
N7
94
DD as ment Permit
PERMIT NUMBER STREET a DO CHECK
Required
0 YES QNO_
CITY
TELEPHONE NUMBER
METER SIZE
SERVICE SIZE CLEARANCE CHECKED BY
Z
STATE LICENSE R—UMBER—
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
61
TYPE CONNECTION
VERIFIED BY
A V_
I
6IZ9
C/
PERC. TEST
PERMIT NUMBER
FIRE &ONE TYPE OF 77UCTION STREET IMPROVED
Z
NO
SPECIAL INSPECTOR REQUI RED OCCUPANCY GROUP
YES ErINO
PLAN CHECKED BY
WORK TO BE DONE
N0.0FULD06. PERIBLOG. TOTAL FKA
BUILDING
VALUATION
600
FRILDING PERMIT
)p to
EE 0
NUMBER OF STORiF
NEW DEaLISH
PLUMBING
3
ADD
PERMIT FEE
HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF
4 PERMIT FEE
DWELLING
DEMOLITION
REPAIR NON-RESIDENTIAL �-UNITB
5 PERMIT FEE
AMOUNT DUE
6
I hereby acknowledge that I have read this application; that the in-
ATTENTION
APPLICATION APPROVAL
formation given Is correct: and 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 PERBUT
This application Is not a permit until
1&ting construction; 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, arid
relating to Workmen's Compensation Insurance.
WORK NOTED
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
SIGNA RE (OWNER OR AGEN D ATE 8
INSPECTION
DEPARTMENT
)IIGN
1:);I RE C T ATURE
4::.
;�:CT
6
CITY OF
EDIVIONDS
DATE
LOT PLAN ECK & APPROV
PR 0.1107
FILE
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