660005.pdfBUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
W11T APPLICATION
(OR NAME OF NUSINESS)
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NO.: BUILDING
PERMIT
NUMBER 6 0
USE ZONE
LOT AREA.
VACANT SITE
IAI 4
YES [3 NO
0
TELEPHONE NUMBER
HEIGHT
BUILDING AREA VARIANCE NU �ER
x.
PLOT PLAN APPROVED
049�2 -,r 1-9
Z
REMARKS
T3,BEPHONE NUMBER
Ac�) 3-3
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REMARKS
Ve (7 e
METER SIZE SERVICE SIZE C LEARANCE CHECKED BY
.
TELEPHONE NU�ER
6V 0.0 C/ IAIA ri.121 J,
REMARKS
LICENSE NUMBER ITY LICENSE NU ER
19T
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST
PERMIT NUMBER
FIRE ZORE-1 TYPE OF
CONSTRUCTION STREET IMPROVED
I E3 YES 0 No
e�/ /Z/
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
0 YES [3 NO
PLAN CHECKED 33Y
VALUATION
TOTAL FIER
1
BUILDING
VALUATION
WORK TO IBM DONE
'�C—/_'& r C.
2
BUILDIIG PERMIT
FEE
S/C4
PLUMBING
r/,( 'W- 'e'4
3
PERMIT FEE
;ra—
HEAT & GAS LINE
Al C'j
PERMIT FEE
SIGN PERMIT
1:1 NEW
1
[j
E] SIGN
NUMHZR OF STORIES
DEMOLISH
5
FEE
6
DEMOLITION
PERMIT FEE
ADD
FENCE
N BER OF
ALTER
RESIDENTIAL
7
PLAN CHECK
El R
1:1 NON-RESIDENTIAL
LLI
D=E NG
I UNITS
FEE
8
AMOUNT DUE
;2, 0-0
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given to correct; and that I arn 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 TIEE;
relating to Workmereo Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
'1xcopt Demolitions which sball
NOTE: Permit Limit One Year
receipt Is acknowledged In space provided.
be completed in ninety dayn.)
SIGNATURE (OWNER OR AGENT) DATE IGNED
INSPECTION
ON T
DEPARTMENT
CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Cherk Fee
I-R 6-1107
Thin Permit covers work to be done an privnte property ONLY.
Any construction on the public domain (curbs, sidewalks. driveways,
FILE
marquees, etc.) will ft-guire RePtUnte PerInt"PlOn-
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