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PLAN FILE NUMBER BUILDING r,
+ FIH PERMIT
UU111ding
Permit APPlication I InsIdPoPH—cavy Lines
NUMpjFR b4U4bJ
NAME (OR NAME OF BUSINESS)
JOB ADDRESS
AL�
i
MAILING JLDDRE138
7e; 241C
SIDE YARD
BACK
REAR YARD
—1c
CITY NUMBER
USE ZONE
MAP NUMBER
VACANT SITE
1,0TELEPHONE
of
C-1-917 6? 17CIS Aq e, �J_V. 3 6�
0 YES NO
14AME
_TURILDING AREA
LOT AREA
VARIANCE NUMBER
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
CITY TELEPHONE NUMBER
REMARKS
NAM
R
ADDRESS
Encroachri(cht Permit PERMIT NUMBER STREET GRADE CHECK1,,
Required 1 1
or.
4
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE BY
1
ICRECKED
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1 0 YES [3 No
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
0 YES NO
PLAN CHECKED BY
WORK TO BE DONE
NO. OF BLOOD.
PERIOLDO.
TOTAL FEE
BUILDING
VALUATION
2
"*Ed ERMIT
FEE
FEE
NUMBER
PLUMBING
NEW
DEMOLISH
I
3
PERMIT FEE
ADD
4
HEAT & GAS LINE
PERMIT FEE
El
NUMBER OF
ALTER
RESIDENTIAL
REPAIR
NON-RESIDENTIAL
DWELLI G
IN
UNITS
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
e
I hereby acknowledge that I have read this application; that th in-
ATTENTION
APPLICATION APPROVAL
formation given In correct; and that I am the owner, or the duly auth or-
lzed 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
relating to Workmen's Compensation Insurance.
WORIC NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt Is aelmowledged in space provided,
INSPECTION
SIGNATURE (01�1�Ott AGENT) DATE SIGNED
DIRECTOR'S 81 TURE
`7
DEPARTMENT
CITY OF
DA17/
EDMONDS
PLOT PLAN CHECK & APPROVED
IIR 6.1107
FILE
I v
C)
OF INSP
Date Passed
1%
Foundation
Plumbi ng'(Partial)
(Rough)
Frame
Furnace & Fuel Ones
Final,