640360.pdfApplicant Fill
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K PLAN FILE NUMBER
L A N ""U
BUILDING
PERMIT 640360
NUMBER
AD EBB
OB ADDR
0
J B
SIDE YARD
SET BACK
REAR YARD
SE ZONE
U S ZOV
U I. -
[11EIG
YES [:I NO a
I IIl -
BUILDIWG AREA
BU L C
LOT AREA
VARIANCE NUMBEN
I HT
IT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
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ADDRU58
.9
CITY
NUM1JER
A
5,9 7 7— 11,119
0
—7
RATE L-ICEN13E NUMBER
LOT
BLOCK TRACT
WORK TO BE DONE
0 ILI V'F /j-� es;- 6 /1/
Al
DEMOLISH
WOE
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR F-1 NON-RESIDENTIAL I UNITS
I hereby acknowledge that I have read this application; that the in-
formation given Is 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-
lating construction; and In doing the work authorized thereby, no Person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
FILE
REMARKS
To=roachment PC
PERMIT NUMBER STREET GRADE CHECK16
Required
n YES NO
METER SIZE SERVICE
SIZE CLEARANCE CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1 0 YES [j No
-SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES 13 NO
PLAN cHEuKkul) BY
NO. OF BLDGS. PERIOLDG.. TOTAL FICK �r
BUILDING
I VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
3EMOLITION
5 PERMIT FEE
6 AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTnonizEs
signed by the Director of Building Inspec-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
I
receipt is acknowledged in space provided.
INSPECTION
D=CT IS E
DEPARTMENT
Dir yk, Bldg. Official
CITY OF
D L
EDMONDS
Zz.
PR 6-1107
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