650193.pdff
Building Permit
I"T
Applicant Fill
,
Application I Inside Heavy Lines
'ILE NUMBER
P LAN FILE
PERMIT
NUMBER 6j50193
NAME 1QR NAME OFB EBB)
N
JOB ADDR'
JOB ADDRESS
/2�1
Z41 ,
I
P9
MAILING ADDRESS
C7
ks
SIDE YT��
IU
SET BACK
TLInes
CITY
F /y)
TELEPHONE NUMBI1
o 0 6
USE ZONE
MAP NUMBER
VACANT SITE
YES NO
NAME
BUILDING AREA
LOT AREA
VARIANCE NUMBER
I
DDRESS
HE G
'I HT
ALL BUILDING SETBACKS
I NOTE: TO EAVE LINES
ow
TELEPHONE NUMBEA
REMARKS
A
EncroachmetM' Permit PERMIT NUMBN" STREET GRADE; CHECK
Required
n YES -1 NO
TELEPHONE NUMBER
METER SIZE I SERVICE SIZE CLEARANCE CHECKED BY_
;R
CITY LICENSE N umTR
REMARxs
TRACT
PERC. TEST PERMIT NUMBER
11,3 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
1 0 No
0 YES
0 YES El NO
-
BUILDING
VALUATION
BUILDING PERMIT
2
2
FEE
R
14UMISER OF STO E
IT 0
PLUMBING
NEW
0 DEMOLISH
I
I
3
3
PERMIT FEE
ADD
—
4
4
HEAT & GAS LANE
PERMIT FFE
ALTER
REPAIR
RESIDENTIAL
NON-RESI
NUMBER OF
DWELLING
UNITS
5
5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
th
1 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
r
Ized agent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
I
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!8 Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
INSPECTION
DEPARTMENT
CITY OF
3IGNATURE (OWNER OR AGENT) DATE SIGNED
d
EDMONDS
LOT PLAN CHECK & APPROVED
PR 0-1107
FILE
I
I I -=Pl � C11 C_� I
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.
I
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