640385.pdfI
PLAN FILE NUMBER BUILDING
IpplIcant FIR
Building Permit App ication I
PERMIT 640385
In side Heavy Lines
NUMBER
NAME (OR NAME OF BUSINESS)
JOB ADDRESS
T;Z 0(7 eV —
MAILING ADDRESS
SIDE YARD-
SET BACK
REAR YARD
USE ZONE
MAP NUMBER
VACANT SITU
TELMPHONE NUMBIla
C/ Jr
'10ffl
BUILDING AREA
LOT AREA
0 YES 0 NO
VARIANCE NUMBER
NAME
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
ow
TO E&VE LINES
CITY
TELEPHONE NUMBER
REMARKS
NAME
Z'pe,-'s vol�r r�ci� d1z
PERMIT NUMBER
ADDRESS Encroachment P STREET GRADE CHECK1,S
Required 1Z
/ 0 YES NO I I N
CIW� TELIFMHOX�E NUMBER METER SIZE) SERVICE SIZE CLEARANCE CHECKED BY
-'7 1' 1/.>/%l .14r'pr-e I
STATE LICENSE NUMBER CITY LICEN13E NUM�&BE REKARKs
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
FIRE zONE TTFE MOF CONSTRUCTION STREET IMPROVED
Z I El YES [3 NO
0 SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES [] NO
PLAN CHECKED 13Y
x
WORK TO BE DONE
NO. OF 13LOGs. IP Is R I FIB L 10) 101. TOTAL FEE Z
BUILDING
VALUATION
BUILDING PERMIT
NUMBER OF STORIE 2 FEE 40
-2 z
NEW DEMOLISH PLUMBING
ADD 3 PERMIT FEE
HEAT 4, GAS 12NE
F-1 ALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
5 PERMIT FEE
0 AMOUNT DUE
I hereby acknowledge that I hL� , read this application; that the in-
formation given Is correct; and that I am the owner, or the duly authw- ATTENTION APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu- TIUS PERMIT This application is not a permit until
lating 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
relatIng to Workmen -a Compenar.t!qn Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR receipt k is acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) A NED INSPECTION DIR JCR.8)81G�N�
DEPARTMENT ML KRE
e. ft YR Idg.Ofricial
CITY OF
DATE.
PLOT PLAN CHECK & APPROVED EDMONDS 7
PR 0-1107
FILE