640429.pdfBEEN
1C__
IA=
WORK TO BE DO
OD
�S'O.
LAN FILE NUMBER BUILDING
PERMIT 640429
NUMBER
:)B ADDRESS
TELEPHONE NUMBER
USE ZONE
MAP NUMBER
ACANT 13ITE
9;-- 7 -17
(�f /
I
XYES [] NO 0
BUILDING
T AREA
VARIANCE NUM13ER
HEIGHT AT.T. BUILDING SETBACKS
NOTE:
TO EAVE LINES
TELEPHONE NUMBER
REMARKS
1
Encroachment Permit PERMIT NUMBER
8 TREET GRADE CHECK
Required
YES 11 NO
TELEPHONE NUM13=
METERsIzE. SERVICE SIZE
CLEARANCE
CILECKE BY
7
I
I
CITY LICENSE NUMBER
Rrs
CT
640 Z_J 2;�)ee. AJ 0
0
TYPE CONNECTION VER377EIV
A 7))__) T-)
PERO. TEST PERMIT 1�f!BER
Xjr!y- Tn ?
FIRE ZONE TYPE OF CONSIMMV37ION STREET IMPROVED
=-p / /,j tfoL O.A-f C��-
Z, 1 W48
lu:::: ! # 9 [j No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES 0__NG
PLAN CHECKED BY
7- 0 (.M/ 17-
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
NEW
ADD
DEMOLISH
NUMBER OF STO 8
�z
3
PLUMBING
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
Lai RESIDENTIAL
1 1:1 NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS 2e'?
1
5
DEMOLITION
PERMIT FEE
PROPOSED USE
20 OeV/7_ 4;P7_,
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly author-
ATMNTION
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
THIS PERMT
AUTHORIZES
ONLY THE
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
WORK NOTED
DATE - SIGNE
/1�11,z
INSPECTION
DEPARTMENT
CITY OF
PLOT PLAN CHECK & AF.,P D
EDMONDS
,P6VE
PR 6-1107
FILE
PERIBLDG. TOTAL FEE
06 0
tin
12— F,4)0
I 1��/, _7_s� 1
APPLICATION APPROVAL '
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
I