640440.pdfApplicant FIR
Permit Applicationj Inside Heavy Lines
MAI A _VESS
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ADDRESS
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'LAN FILE NUMBER
BUILDING
PERMIT 640440
NUMBER
OB ADDRES13
UDE RD
SET BACK
REAR YARD
USE ZONE
MAP NUMBER
VA6��
/(/q/
S'u)
0 YM13 No
PW
3UILDING AREA
LOT AREA
VARIANCE NUMBER
FIBIGHT
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
REMARKS
Encroachment Permit PERMI NUMMER STREET RADE CHECKIi
Required
WZ
0 YES NO
METER SIZE
sEavICE SIZE CLEARANCE ICHECKED BY
REMARKS
c-n
[] YES
BUILDING
VALUATION
1
2
BUILDING PERMIT
FEE
IT$1
NEW
ADD
DEMOLISH
NUMBER OF STORIES
3
0_1 —
PLUMBING
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
_Uay NON-RESIDENTIAL
NUM13ER OF 4
DWELLING r
UNITS 5
DEMOLaTION
PERMIT FEE
AMOUNT DUE
—1
PROPOSED USE
6
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- ATTENTION
ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
will be employed in violation of the Labor Code of the State of Washington ONLY TILE
relating to Workmen's Compensation Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
I URE (OWNER 0 NT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMOND
�OT PIJLryC_jIECX & AP OVED
77, PR 0-1107
FILE
[] No
TOTAL FKK Z
ra
? _r, S10
�61 60
I Ilell-ro I
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.