650199.pdfFill
PLAN FILE NUM13ER BUILDING
PERMIT 650199
Building Permit
Applicant
Application Inside Heavy Lines
NUMBER -
NAME (OR NAME Ul" BUSINESS)
JOB ADDRESS
-MAILING
ADDRESS SIDE YARD
SET BACK IREAR
YARD
CITY
TELEPHONE NUMBER
USE ZONE
MAP NUMBER
VACANT SITE
4�8 [3 NO
NAUS
BUILDING AREA
LOT AREA
VARIANCE NUMBER
HEIGHT
ILDING SETBACKS
9k
NOTE: AL011EBAUVE LINES
CITY
TELEPHONE NUMBER RE RKS
JH
NkME
jd� A4
C!
0
ADDRES13 Encroachment Permit PERMIT NUMBER ISTRErT GRADE CHECK
Required
I I
Z
r3 YES 0 NO
W.
i
CITY
TE"k'&IVNE NUMBER
METER SIZE
—
SERVICE SIZE CLEARANCE CRECHE BY
I
Q
STATE LICENSE NUMLiER
CITY LICENSE; NUMBER REMARKS
LOT BLOCK
TRACT
0
lVdMc� T
�2 AZ Z4�E
r VERI
YPE CONNECTION D Y
Im
I
PE UMBE
PERC.TjST
I
Z
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES
PLAN CHECKED BY
Z �E-12___V
1
WORK TO BEIDONE
No. OF 8LDG5. PERIBLOG. TOTAL FEE— z
BUILDING
VALUATION
o
NUMBER STORIE
BUILDING PE.I.MIT
2 FEE
41 1
OF
NEW DEMOLISH
PLUMBING
r_1 I
3 PERMIT FEE
Z/ r)
ADD
—
I
BEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF
4 PERMIT FEE
DWELLING
DEMOLITION
REPAIR NON-RESIDENTIAL UNITS
5 PERMIT FEE
RR—OPOSED USE
6 AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
format4on 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
This application Is not a permit until
latIng construction; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR
;IGN URE WNNA UR AUN�W) DATE SIGNED
I i
INSPECTION
DEPARTMENT
DIRECTOR'S BIG NATURE
CITY OF
_�4
law EDMONDS
LOT PLAN CHECK &1 APPR�VED
DATV---
X;"i
rn 6-1107
FILE
-70
............
75�
[RECORD OF INSPECTIONS
Date Passed
Foundation
7/
a