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PLAN FILE NUMBER SUH.DING
Applicant Fill NUMBER 640441 ;
? ®wilding Permit Application Inside Hea Lines
NAME (OR NAME OF BUSINESS) JOB ADDRESS I .
K REAR YARD
SIDE YARD
+. .. a DRESS
3
is.8201.�VK C. V�f�w
a O TELEPHONE NUMBI+:R. USE ZONE MAP NUMBER VAOANT SITE '
CIrrT'Y tt r�
W% Cv% N S C- % ••)/ I YES NO
(NAME BUILDING AREA LOT AREA (VARIANCE NUMBER I�
D �. HEIGHT ALL BUILDING SETBACKS
k NOTE: TO SAVE LINES
CITY TELEPHONE NUMBER REMARXB -
;
NAME
0. irtl.F�ls�s f 1
1,
ADDRESS
Enc ermit P T NUMBER STREET GRADE CHEO '
O
'Required 'pYj r
YES NO j
t !4 �� I TELEPHONE NUMBER METER SIZE SERVICE SIZE CLEARANCE I CHECKED BY. j
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4 it7 .'
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�• S TAE NUMBER CITY LICENSE NUMBER REMARKS .
_ , y0•r BLOCK I TRACT (
t �} 1 �r+'f
TYPE CONNECTION I VERIFIED BY
ILLr n% PERC. TEST PERMIT NUMBER I FILL,
Ir
FL
ZONE TYPE OF CONSTRU ON S FtEB;'1'
YES i] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES El NO
LF
• PLAN CHECKED BY -
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WORK TO BE DONE FILL, ,,AA- NO. OF OLDOO. P[RIOLDO. TOTAL PER '��gy, LrIF
IF
`V`•O0 V%P%F Ih �ct �l-�e BVILDINa
ffr VALUATION r [J b 6i
(r� �� i of Q L-`1 V Cti"�� ✓-ti L) R. • �"� BUILDING PERMIT
2 FEE 11 1IhILI
NUMBER OF STORIES
❑ NEW DEMOLISH PLUMBING ,
❑ I 3 PERMIT FEE .
ADD
® HEAT A GAS LINE i.
®ALTER I RESIDENTIAL I NUMBER OF 4 PERMIT FEE I
aDWELLING I DEMOLITION
REPAIR NON-RESIDENTIAL UNITS 6 PERMIT FEE
PROPOSED USE I
l� Oe,�.i 5�otralN. hw.. f�j/ '. ' '
RelGr@atiieh Riot" •) 6 AMOUNT DUE
I hereby acknowledge that I have reed this application; that the In -I ATTENTION APPLICATION APPROVAL If I
IF
formation given is correct; and that I athe owner, or the duly author-
m
ized agent of the owner. I agree to comply with city and state laws regu• THIS PERMIT This application is not a permit until I
lating construction; and in doing the work authorized thereby, no person AUTHORIZES signed by .the Director of Building InsL
will be employed In violation of the Labor Code of the State of Waahingtoa ONLY THE tlon, or his deputy; and fees are paid, and �.
relating to Workmen's Compensation Insurance, WORK NOTED receipt is acknowledged in apace provided.
NOTE: PERMR LIMIT ONE YEAR IxePEcrlox
sIGN T (OWN OR AG T) DA E SIGNED DIRECTO 's NATURE
/ DEPARTMENT
CITY OF TE
EDMONDS I'
I PLOT PLAN CHEOK APPROVED I / �. 7 L
PR 6.1107 j
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