640419.pdfApplicant Fill
Building Permit Applicationi Inside Heavy Lines
PLAN FILE NUMBER
PERMIT 640419
�IBER
NAME (on NAME OF BUSINESS)
JOB ADDRESS
S�'
HAROLD 0, i<0Ra0L
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NAME
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BUILDING AREA LLOT REA VARIANCE NUM R
ADDRESS
-FfE—IGHT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
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CITY 'YE—LEPHONE NUMBER
MARKS
NAME
-7.4 C 14 0 4 1/ P,
ADDRE138
EncroachmenF/Permit PERMIT NUMBER STREET GRADE C
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Required
n YES n NO I I
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METER SIZE SERVICE SIZE CLEARANCE BY
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TYPY, COP�NECTION VERIFIED BY
ERq/ TEST PERMIT NUMBER
FIRM ZWE TYPE OF CO JriON STREET IMPROVED
Vk__ I 1 0 YES NO
SPECIAL INSPECTOR REWuIRED
OCCUPANCY Or
YES 01fro
PLAN CHECKED BY
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WORK TO BE DONE
NO. OF SLOGS.
PERIBLDG.
TOTAL FER
BUILDING
VALUATION
L
2
BUILDING PERMIT
FEE
-0
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F-21 NEW
D DEMOLISH
NUMBER OF STORIE
PLUMBING
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3
/7-. 6-V
PERMIT FEE
ElADD
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4
HEAT & GAS LINE
PERMIT FEE
C� 0
ElALTER
RESIDENTIAL
NUMBER OF
El REPAIR
NON-R
DWELLING
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 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
tion, or his deputy; and fees are paid, and
relating to Workmen's Compensation Insurance.
WORK NOTED
receipt is aelmowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION
DEPARTMENT
DATE SIGNED
DIRECT7SGNATURE
CITY 01
EDMONDS
DATE
OT pL&N.,CHNCjt/& APPROVED
PR 6.1107
115? X,
FILE
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