650165.pdfrrr
PLAN FILE NUMBER BUILDING
Applicant Fill PERMIT 650165
Juilding Permit Application inside Heavy Lines NUMBER
NAME WR 14AME 0 USINESS) JOB ADDRESS
I A
MAILING ADL)Rhibb SIDE YARD SET BACK REAR YA"
CITY TE PHONE VUMBNR U,SE'ZONE MAP NUMBER VACANT SITE
YES 0 NO
NAME BUILDING AREA LOT AREA VARIANCE NUMBER
ADDRESS HEIGHT ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
CITY I TELEPHONE NUMBER REMARKS
NAME
ADDRESS Encroachment Permit— PERMIT NUMBER STREET GRADE CHECK1.
Required
Q YES 0 NO
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CRECKE137BY
Q
STATE LICENSE NUMBER
CITY LICENSE NUMBER
LOT BLOCK TRACT
<7
_j- 16,
[I YES [] NO
47--Z, ,
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
NEW
IF] ADD
DEMOLISH
I I
NuMi3kill OF STORIES
I
3
PLUMBING
PERMIT FEE
4
H T & GAS LINE
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NU R OF
D LING
UNITS
5
DEMOLITION
PERMIT FEE
61 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In. ATTENTION
formation given Is 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- THIS PERMIT
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
�a
'y t ' h e h
U
In*
or -
we r rgu-
no pc son
as
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
Ir L INSPECTION
jFjGgATT4jRE (0�%�VNER OR �AQENT)�i D�ATESIGNED
DEPARTMENT
r
CITY OF
ED310NIDS
�O_T PLAN CHECK & APPROVED Pit 6-1107
FILE
0 YES 13 NO
APPLICATION APPROVAL
This application is not a perinit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
Z
W
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