650045 (2).pdfa"
PLAN FILE NUMBER
BUILDING
Building Permit Application
ApplIcant FIB
I Inside Ilea Lines
PERMIT
NUMBER 650045
NAME (OR NAME OF BUSINESS)
JOB ADDRESS
MAILING ADDRESS
SIDE YARD
SET BACK nEAR YARD
CITY
TELEPHONE NUMBER
U")ZPNE
MAP NUMBER
VACANT SITE
74 Sy a .-
I
'b (,Y E 8 [j NO
NAME
BUILDING AREA
LOT AREA
VARIANCE NUMBER
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
—61-T—Y
'INLEPHONE NUMBER
REMARKS
NAME
ADDRESS
Encroachment Permit
PE RMIT NUMBER STREET GRADEICHECK
Required
FIYES E] NO
R
CITY
TELEPHONE NUMBER
INIETER SIZE I SERVICE SIZE
CLEARANCE CRECHE BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT iH3eeX- TR*0T -tdOW
D; V, 5e—,57 ei�
1141-e /
err —
TYPE C NN C N
VERIFIED BY
2
PERC. TEST
'PERMIT NUMBER
FIRE Z NE TYPE OF CONSTRUCTION STREET IMPROVED
C] YES NO
--72—
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES 2-IrO
2
Q
PLAN CHECKED BY
WORK TO BE DONE
NOe TOTAL FEE
Z
BUILDING
1 VALUATION
BUILDING PERMIT
2 FEE
NUMBER OF STORIE
NEW DEMOLISH
PLUMBING
3 PERMIT FEE
0
ADD
eq
FjALTER RESIDENTIAL NUMBER OF
HEAT & GAS LINE
4 PERMIT FEE 11�0
DWELLING
NON-"Sl UNITS
1:1 1
DEMOLITION
REPAIR
5 PERMIT FEE
PROPOSED USE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given In correct: and that I am the owner. or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
14 THIS PERIMIT
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 Inspee-
will be employed in violation of the Labor Code of the State of Washington
-a Insurance.
ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workmen Compensation
WORK NOTED
receipt is acknowledged in space provided.
NOTE: PERMIT L"IT-ONE YEAR
SIGN T RE (OWN i.,_OR�AUENT) DATE SIGNED
,
7,
INSPECTION
DEPARTMENT
DIRECTOR' 8 SIGNA`rt�IJE
(_ " ___
1�,,
CITY OF
� �-� ��,;
DATE C,-
__7 I
EDMONDS
PLOT-131,�N CHECK, & PPROVED
PR 6-1107
FILE
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