650018 (2).pdf.... ... ... ...
41ding Permit Application I In S'l dPeP'1'1'e a"N'y FEW c
fAME (OR NAME OF BUSINESS)
EA
I ILING ADDRESS 7-11
Vlllr�61 I
o IeY_
7
IITY —TELEPHONE NUMBER
W� 0 /V�v 1.4-1- 3 h'r--s-,
� 4:1 -.::;- 7 -
IF Yr
ZONE
Encroachment Permit
Required
0 YES [3 NO
CITY
TELEPHONE NUMBER
METER SIZE I BERVICI
.4-
STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
77
-Vte-
TYPE CONNECTION
�UITIQ,,AJ S' S?�J V1 &C-1" 71t -1 4!�
PERC. TEST
1-0 T7f If- )1'1_4� 771C-<&a e
FIRE ZONE TYPE 0
C-co lw—'eer-� ol �,L-I-v
0
OF -7�rr
SPECIAL INSPECTOR F
7( Ig-67c o 17-a-I&S
0 YES NO
Q
4!f-o, or -
PLAN CHECKED BY
WORK TO BE DONE
0 e\fj J_Lj&� Aj !I? PdZ L
BUILDING
VALUATION
BUILDING PERMIT
NUMBER OF STORIES
2 FEE
NEW
DEMOLISH
PLUMBING
3
PERMIT FEE
ADD
HEAT & GAS LINE
PERMIT FEE
ALTER
RESIDENTIAL
NUMBER OF 4
NON-RESIDENTIAL
DWELLING
UNITS
I
DEMOLITION
REPAIR
— 5
PERMIT FEE
PROPOSED USE —
v 6V-Fr -tt,- 6
AMOUNT DUE
th
I hereby acknowledge that I have read thin application; that the, In-
ATTENTION
or
formation given to correct; and that I am the owner, or the duly author-
re
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 THE
relating to Workmen's Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
RE (0 714E�� V A NT) DATE SIGNED INSPECTION
�5u 71 DEPARTMENT
117,1 4� J CITY OF
EDMONDS
PLAN CHECK &-APP D
I �-- ) 7 1 -
FILE
BUILDING
PERMIT
NUMBER 650018
SET BACK I REAR YARP
.,�?J 7—
VACANT SITE J
0 YES 0 NO
VARIANCE NUMBER
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
OF BLDG8.
[] YEII 13 NO
Of
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 acknowledged In space provided.
door
I p