650223.pdfApplicant Fill
Building Permit Application lInside Heavy Ines
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PLAN FILM NUMBER
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BUI
PERMIT
NUMBER 650223 1
ME_JOR NAME OF �P!Irlqsa)
NAM
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JOB ADDRESS
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BEAR YARD
ITY TELEPHONE NUMBF;R
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USE ZONE
MAP NUMBER
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0 YES 0 NO
0
BUILDING AREA
LOT AREA
VARIANCE NUWB--ER
ADDRESS
HEIGHT
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
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NUMBER
REMARKS
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NAME
ADDRESS
Encroachment Permit PERMIT NUMBER STREET GRADE CHECK
Required
n YES NO
CITY
TELEPHONE NUMBER
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
LOT BLOCK TRACT
2.
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES [j NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
I
[] YES ,�O
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PLAN CHECKED BY
WORK TO BE DONE
NO. OF OL.005.
PERIBLOG.
TOTAL FOE
BUILDING
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Al;jee L-Meel-
VALUATION
BUILDING PERMIT
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FEE
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PLUMBING
PERMIT FEE
DEMOLISH
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4
BEAT & GAS LINE
PERMIT FEE
RESIDENTIAL
NUMBER OF
ALTER
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5
DEMOLITION
PERMIT FEE
ElREPAIR
1:1 NON-RESIDENTIAL
DWELLING
UNITS
PROPOSED USE
F-1-77:-
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given is correct: and that I ara the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu.
THIS PERBUT
This application Is not a permit until
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
AUTHORIZES
ONLY THE
signed by the Director of Building Inspec-
relating to Workmen's Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR-
INSPECTION
DEPARTMENT
CITY OF
receipt is aclmowledged In space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DIRECTOR'S SIGNATURE
EDMONDS
DATE
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PLOT P CHECK & A�PPPROVED
PR 6.1107
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