650059 (2).pdf,
Building Permit Al
NAME (OR NAME OF BURIN
a S42 7
MAILING ADDRESS
i CITY
Applicant Fill
Inside Heavy Lit
I / i
Encroachment Fermi
Required
rl YES fl NO
❑ YES i] NO
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BUILDING
I VALUATION
BUILDING PERMIT
I 2 FEE
NUMBER OF STORIES
NEW DEMOLISH / PLUMBING
ADD 3 PERMIT FEE
HEAT & GAS LINE
ALTER I SIDENTIAL I NUMBER OF 4 PERMIT FEE
DWELLING
1:1REPAIR1:1 NON-RESIDENTIAL UNITS DEMOLITION
0 PERMIT FEE
PROPOSED USE
0 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author- ATTENTION
Ized agent of the owner. I aMe 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: P"RMIT LIMIT ONE YEAR
SIGNATURE/ OWNER OR AGENT) DATE BIG D INSPECTION
DEPARTMENT
C l / o �L U t�--� la CITY OF
PLOT PLAN- ECK & ¢ri' OVED EDMONDS
PR 0-1107
FILE
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PERMIT
NUMBER 650059
1AY "UAIt ZI[ vtt...v.&
/ % e. i E3 YES NO
T AREA I VARIANCE NUMBER
ALL BUILDING SETBACKS {st
NOTES TO EAVE LINES
PERMIT NUMBER IARTREET GRADE CHECKI
W
TOTAL F«
x
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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.
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