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650445.pdfKROLL MAP NO.: BUILDING PERMIT BUILDING DEPARTMENT Applicant Fill 650445 Cal NUMBER Inside Heavy Lin JOB ADDRESS PERMIT APPLICATION W-m— &L;) Cd CJ 42 VX MAILING AJ 6 s- 2. I -, t, BUSINESS) is V eV4 AV I TELEPHONE NUMBER 3 Y, �MAJEPHONE NUMBER ulo Co ill i� f I:, I-POVA lake Die 'XNL,WrklVr4E NUMBER LA 5 7444 I � NUMBER CITY LICENSE NUMNEOR �f Property (Show Bel ow or Attach Four Copies) -+ -�_ Tl,.,, 0, vi-a 5 .&AA "' 2— SIGN NEW I ADD D H FENC ft F ALTER F-1 RESIDENTIAL NUMBER OF F] REPAIR NON-RESIDENTIAL DWELLING UNITS I hereby acknowledge that I have read this application; that the in- formation given In correct; and that I am the owner, or the duly author- lzed agent of the owner. I agree to comply with city and state laws regu- 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 relating to Workman's Compensation Insurance. (Except Demolitions which shall NOTE: Permit Limit One Year be completed in ninety days.) 12 1?16 NOTE: Applicant Subject to Plan Check Fee This Permit coven work to be dune on private property ONLY. Any construction on the public domain (curbs. sidewalks, driveways, marqums, etc.) will mquire separate permission. /,J LOT AREA VACANT SITE 0 YES 0 NO a EIGHT B DING AREA VARIANCIS NUM-UNn UUT _PIAN APFROVED XUARKS LEMARKS Z &ETER SI CLEARANCE CHECKED BY tEMARKS rYPE CONNECTION VERIFIED BY ?ERC. TEST PERMIT NUMBER FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROV I I [] YES 0 NO 0 YES [J NO BUILDING VALUATION BUILD IG PERMIT 2 FEB PLUMBING 3 PERMIT FEE HEAT & GAS LINE 4 PERMIT FEE SIGN P �RMIT 5 FEE DEMOLITION PERMIT FEE PLAN CHECK 7 FEE 81 AMOUNT DUE ATTENTION THIS PERMIT AUTIlOR1ZE8 ONLY TILE WORK NOTED INSPECTION DEPARTMENT CITY OF EDIVIONDS PR 0-1107 I I / 1Z /�) U I 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. = DATE �/7 FILE Z 0 I I w7 Al I t L P r�z d I Qo, d 4L L I % t I Appl. No . ... . ...... ........... Permit limit, one y ' ear APPUCATION is hereby made for a permit to construct the following work, in accordance with the accom, panying plans and specifications. Two sets are submitted herewith for approval. Off -St. new w" alter %ol. Work addn repair ...... .................... Parking Z-e .......... ............. ................................................... ne.. anc ...... V&nst. e, ...... Use zo Fire zone.. moo .......... ........ Addn Address. ... ................... - --------- - --- ....... .. ....... Blk !��VL ic tAnk ........... . rontage.. . ................................... Area ........................................... Sept ...................... ------- setbacksfront ............................ r. side ....... Z.2 .............. 1. side .............................. rear ............................. Tel. No ............................. .,Owner ... ta . ........................ Address. le CIP e4 ............... ................ �Address.. T BUILUrL ... ....................... :�� � C � ;2;4� ... ........ .................... ;r. el. N Plansby ................................................................. Address .................................................... Tel. No ............................. Remarks................................................................................................................... The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this work. ......... Address ............................................ Date: ....................... Signed Owner/Agen PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap, proved plans and specifications, and Building Department notations thereon. Valuation Permit fee ....... ........ Recd. by.. ............ -';�A# --r . ........ 10 r. (4 4/-1,.6 .. 0 ........................... Building Department, By ....................................... eld .. ) .. J1 . .................. Date ........ / ... 7.. INSPECTION RECORD Fdn, OK ............................................ Frame, OK .................................................... Final, OK ....................................... This Permit does not cover Plumbing, Sewer or Electrical installations.