650058 (2).pdfPermit Application I "Or
BUILDING
PERMIT 650058
NUMBER
&'L'—�
Z6� y �i
L., '�
IDE YARD
SET 33ACK
7EAIR YARD
77�
ONE NUMBER
USE —ZONE
j2ACT NUMBER
SITE
VACA14X MLK�
V C7
NO
3147
0 YES 13
0
dF
BUILDING AREA
�E AREA
VARIANCE 14UM"�
HEIGHT
ALL BUILDING SETBACKS
lk
NOTE: TO ELVE LINES
MARKS
TE�FHONE NUMBER
02
0010
c achment Permit
PERMIT IN UMZNM rREET GRADE CHECK
Required
rl YES r] NO
E NUMBF4
METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
MBER
CITY LLONN1319 NUMBER
BLOCK TRACT
NECTION
VERIFIED BY
PERO. TEST
PERMIT NUMBER
FIRE ZONE TYJP—E OF CONSTRUVrAuri
STREET
0 YE13 NO
NEW DEMOLISH
ADD
____j
R RESIDENTIAL R OF
ALTER M"I rDwELLING
REPAIR NON-RESIDENTIAL UNI�a
RO 0 1) U E
eel
I hereby acknowledge that I have read t/15 a1pplication; that the In-
formation given Is correct; and that I am the owner. or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu,
lating construction; and In doing the work authorized thereby. no person
will be employed In violation Of the Labor Code of the State of Washington
relating to Workmen'S Compensation Insurance. :?>
NOTE: PERMIT LIMIT ONE YEAR lhkwl �
PLAN CHECK &
FILE
0 YES [] NO
No. OF BLOOD.
PERIBLOG.
TOTAL FKK
BUILDING
1
VALUATION
2
BUILDING PERMIT
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ArTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
ONLY THE
WORK NOTED
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION
—DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
EDMONDS
DAT6�"
PR 6-1107