650189.pdfI
Applicant Fill
Building Permit Application lInside
PLAN FILM NUMBE4
P LA
BUILDING
PERMIT 50189
6
Heavy Lines
NUMBER
NAME (OR NAME OF BUSINESS)
JOB "DRESS
M ,jUnes
VULi44 Sj' Psom Rititclett-
-2- 2_ -
MAILING ADDRESS
SIDE YARD
BID
SET BACK
REAR YARD
CITY
TELEPHONE NUM Eg
"Sig-
USE ZONE
If" NUIMER
VACANT SITE
fz)momb S WASH
1P jes - A Lo tBo
1 [3 YES NO
NAME
BUILDING AREA
I LOT AREA VARIANCE NuMBE
15
ADDRESS
HEIGHT
Ha
ALL BUILDING SETBACKS
1 NOTE: TO EAVB LINES
N
W126AW1
ADDRESS
I
-ncroachment Permit
Required
rl YES NO
.61
CITY
TELEPHONE NUMBB
METER SIZE SERVICE
EblyD Al D-9 VA
STATE LICENSE NUMBER
CITY LICEN13E NUMBER
REMARKS
LOT BLOCK TRACT
I 1 40
rM F NT RaEm hyd VALL")
—
TYPE CONNECTION
S 7o fT. o7N. F7- eF _rt A T60
.27o
PERO. TEST
yNj05 SF -A UI;T w Tr.4cTs,
FIRE ZONE TYPE 0
ECLAL INSPECTOR R
0 YES [j NO
PLAN CHECKED BY
WORK TO BE DOPE
BUILDING
I
VALUATION
a
BUILDING PERMIT
2
FEE
NUMBER OF STORIES
NEW
DEMOLISH
PLUMBING
ADD
I
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
RESIDENTIAL
NUM13ER OF
ALTER
REPAIR
NON-RESIDENTIAL
I F
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
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 PEWIIT
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 WorkmeWs Compensation Insurance.
WORK Z40TED
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION
SIGNATURE (OWNE)R OR AGENT
DATE.�AIGNED
&
DEPARTMENT
CITY OF
ED31ONDS
PLOT PLAN CHECK & APPROVED
PR 0-1107
FILE
�IMIT NUMBER STREET 30ME CHECK
;E CLEARANCE CHECKED BY
VERIFIED BY
99
PERMIT NUMBER
INSTRUCTION STREET MPRO ED
[3 YES E] No
[RED OCCUPANCY GROUP
PERIBLDG. ___MOTAL FEE
10. OF SLOGS. Z
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 aclmowledged in space provided.
DIRECTO ONATURE
�7
x-5. 101A6T
I)ATE
6
to
I It
i