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BUILDING DEPARTMENT
U 'L D I N
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PERMIT
Applicant
NUMBER
PERMIT APPLICATION
P
Inside Heavy Lines
JOB ADDRESS
N ME (OR NAM E OF BUSTE!8
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13IDE YARD SE-37BACK
13THEET SETBACK
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LOT AREA
ITY
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PH —ONE NUMBEIR
6 ) Z
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HEIGHT
BUILDING AREA
N
PLOT PLAN APPROVED
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or Attach Four Copies)
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117 YES
1,5 i" 0 t, 5 j tl f - L " C:�� -
c 6 j -.;. Jil BUILDING
WORK TO BE DONE I VALUATION
�f e9a, e )I d BUILDING PERMIT
FEE
PLUMBING
1) 3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
NEW ON NUMBER OF STORIES SIGN PERMIT
5 FEE
ADD DEEOLIISH CE
rEN DEMOLITION
NUMBER OF 6 PERMIT FEE
ALTER
RESIDENTIAL DWELLING —
REPAIR NON-RESIDENTIAL UNITS 7 FEE
PROPOSED USE
AMOUNT DUE:
7
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- ATT14CNTION
ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
IE,,ell Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days..) INSPECTION
t ENT? AX SIGNED
DEPARTMENT
13 'fl/ CITY OF
MEN=- I I ii� EDAIONDS
NOTE: Applicant Subject to Plan Check Fee PH 0-1107
This Permit coven work to be. done on private property ONLY.
Any construction on the public domain (curb$, sidewalks, driveways,
marquees, etc.) will require separate permission.
VACANT SITE
13 YES M-110 0
VARIANCE NUMBER 9
[] YES [] NO
ell
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APPLICATION APPROVAL
This application Is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
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