640405.pdfR!�
:77
Applicant Fill
it Application 7�
11ding Perm Lines
LAN FILE NUMBER 5ux�lllu
PERMIT
14TJMBER 640117
NAMM (OR NAME OF BU131,1419313)
JOB ADDREBS,,V,,o
-I—WLINO-"DRESS
SIDE YARD SET BAC REA
J//
UTY TELEPHONE NUMBER
USE ZONE MAP NUMBER VACANT SITE
494 - 7 F-f 7
[j N 0
tNAUE 1.1L, (
BUILDING AREA H r VARIANCE NUM13ER
LOT AREA.
V V7
ADDRESS
HEIGHT
"- I
'91
f ALL BUILDING SETBACKS
I NOTE:
k
TO EAVE L114ES
CITY
ws"PHONE NUMBER
REMPAIRS
7
�NAXE
ADDRESS
Encroachment Fermi STREET G E CHECK
.4
Required
In YES NO
CITY
wis"MONE NUMB
31ETER SIZE SERVICE SIZE CLEARANCE
I
1
� /1. IC
0
LIC—ENSE NUMBER
CITY LICENSE NUM R
rA_TEI
BLOCK
LOT TRACT
TYPE CONNECTION
PERC. TEST T NUMBER
V..
I= ZONE_ TYPE OF CONSTRUCTION STREET IMPRO
I I [] YES
SPECIAL INSPECTOR REQUIRED GCCUPANCY
GROUP
[]-YES [3 NO
PLAN CHECKED BY
WORK TO BE DONE
NO. or 131.068.
PERIBLOG.
TOTAL FRF
1
BUILDING
VALUATION
2
BUILDING PERMIT
al 0
FEE
12rNEW I
El DEMOLISH
NUMBER OF 8 0 E
PLUMBING
ov
ADD
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
-7,
ALTER
RESIDENTIAL
NUMBER OF
DWELLING
REPAIRI
NON-RESI
UNITS
5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
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 PE1011T
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 "a of the State of Washington ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance. WORK NOTED
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
DIRECT IGNAT E
��_e
SIGNKTURE —(OWN]DR Oft AGENT) DATE SIGNED INSPECTION
DEPARTM T
C CITY 0
e
DATE
EDMONDS
PLOT HECK P ROVED
PR 0-1107
FILE
0
77 �71,