640381.pdfFFILAN FILE NUMBER BUILDING
Applicant =FiU PERMIT 640381
11
Ines
vilding Permit Applicationj Inside HcaVV Lines NUMBER
NAM) MOR NAME OF BUSINESS) JOB ADDRESS
-5
7 7 e-7
2- Z 4 -3 P/. &I/ - I -
TELEPHONE NUMBER USE ZONE MAP NUMBER VACANT SITE
YES 0 NO
BUILDING AREA, LOT AREA VARIANCE NUMBER
HEIGHT ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
.'I TELEPHONE NUM13ER
4p
C�
Encroachment Permit PERMIT NUMBER TREET GRADE CHECK]
Required z
I rl NO I r I N
TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
ATE LICENSE WUM-13ER CITY LICENS NUMBER REMARKS
�LOT
7'
TYPE CONNECTION VERIFIED BY
PERC. —TEST PERMIT NUMBER
Flftigg ZONE-1 TYPE OF CONSTRUCTION STREET IMPROVED
13 YES [3 No
z SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0
[] YES NO
PLAN CHECKED BY
WORK TO BE DONE NO. OF 8LDG5. PERIBLOO. TOTAL FXK
z
:;2,-30 6 BUILDING 0
1 VALUATION
BUILDING PERMIT
2 FEE
NEW DEMOLISH NUMBER OF STORIE PLUMBING
3 PERMIT FEE
ADD
I HEAT & GAS 1ADM
QALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING DEMOLITION
REPAIR NON-RES: UNITS 5 PERMIT FEE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- NTION APPLICATION APPROVAL
formation given is correct; and that I am the owner, or the duly allthOr- ATTE
Ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT This application is not a permit until
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 signed by the Director of Building inspec-
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR receipt is acknowledged in space provided,
, (0 UE—)R—OR AGENp DATE kil N INSPECTION DI�IECTO Is 810 ATURE
,177
S I I N TURE (OW11 DEPARTMENT
CITY OF
DAI
EDMONDS
PLOT PLAN CHECK & APPROVED
PR 0.1101
FILE