650200.pdf........... ......
FILE NUMBER BUILDING
Applicant Fill PERMIT 0200
ilding Permit Application Iniside Heavy Lines NUMBER 65
AME kOR NAMN, BUS-1—NESS) JOB ADDRESS D
—SID)3 YA ET BACK YARD I -
IT NUMB us �Zo MAP NUMBER vACA14'17 bVEZ
YES N[.j NO rZ
UMBER
rAME B ILDIN AREA LOT ARE& VA�Ajq�m NUMBER
�DDRESS HEIGHT ALL BUILDI G SETBAC 'a
N
NOTE: TO EAVE LINES
1ITY BFR
IELEPHONE NU REMARKS
17 - <:�, �_, ou ,.4 4
4AME j
C 4?,
�). /R,
kDDRESS Eneroachment, Permit -PERMIT NUMBER STREET GRADE CVHEC
Required
r_1 YES 11 NO
-G ,
[] YES [3 NO
0 YES [:I No
WOFK TO 134 DONN NO. OF BLOOS. -PZRIBLDG. TOTAL FEE Z
BUILDI4G
1 VALUATION
r
BUILDI 11G PERMIT
NUMBER OF STORIES 2 FEE
MNEW 0 DEMOLISH PLUMBING
3 PERMIT FEE
ADD —
_E1 I HnAT & GAS LINE
ALTER RESIDEN NUMBER OF 4 PERMIT FEE
DWELLING
DEMO TION
REPAIR NON-RESI ENTIAL UNITS 5 PERMIT FEE
PROF BED USE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION APPLICATION APPROVAL
formation given to 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 regum THIS PERMIT This application is not a permit until
lating construction; and J12 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 tion, or his deputy; and fees are paid, and
relating to Workmen's CompenBatlor� insurance. WORK NOTED receipt is aclmowledged in space provided.
NOTE: PERMIT LIMIT ONE YEAR INSPECTION W 'SIGNATURE
(OWNER OR AGENT) DATE SIGNED DIRECTOR,
DEPARTMENT
CITY OF
EDMONDS /DATE
PLOT/PLjkN ME k APPROVED.�,,
Pit 6-1107
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RECORD OF INSPECTIONS
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Date Passed
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urna e & Fuel UnCS
Fin,
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