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PLAN FILE NUMBER BUILDING
Applicant Flu PERMIT 640435
Building Permit Application inside Heavy Lines NUMBER
NAME (0 NAME OF BUDINESS) On ADDRESS
k IJFL I- //V 6
MAILING ADDRESS SIDE YARD SET BACK REAR YARD
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CITY TELEPHONE NUMBLR USE NE P NUMBER VACANT 131TE
PAI D -C W14 jAi 2 13,7* 0 YES 0 No
NAME BUILDING AREA LOT AREA VARIANCE NUMBER
hi ADDRESS HEIGHT ALL BUILDING SETBACKS ow
NOTE: TO EAVE LINES
CITY TELEPHONE NUMBER
NAM
S/qm e�
go ADDRESS -Encroachment Permit PERMIT NUMBER STREET GRADE-C—H—ECH
Required
CITY TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEARANCE CHECKED By
STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS
LOT BLOCK TRACT
-P Z-ZIEA 1111-V
L11,Y& K/,Psr- OF ale AV
VERIFIED BY
TYPE CONNECTION
PERC. TEST PERMIT NUMBER
FIRE ZONE7-OF CONSTRUCTION STREET IMPROVED
[3 YES [3 No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[3 YES NO
PLAN CHECKED BY
WORK TO BE DONE
TOTAL FEE
NO. OF HLOGS. PERISLOG. Z j
c/o/ x BUILDING
VALUATION
BUILDING PERMIT
NUMBER OF STORIES 2 FEE
NEW DEMOLISH PLUMBING
3 PERMIT FEE 0-V
2r ADD
HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING
Al DEMOLITION
REPAIR NON -RE SIDE'NTIAL UNITS 5 PERMIT FEE
PROPOSED USE 6 AMOUNT DUE 0, C/ -
131*Tt4 1- IS-Vo L320200M-S
I hereby acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duty author- ATMNTION APPLICATION APPROVAL
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
the Labor Code of the State of Washington signed by the Director of Building Inspec-
wfll be employed in violation of ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
SIGNATUIMnOWN]DR OR AG SIGNED INSPECTION DIREC 810 TURE
DEPARTMENT
CITY OF .Bldg. ofriciai
W APPROVID EDMONDq DA,7,' / / /
PR 6-1107 A"
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