670177.pdfPLAN FILE NUMBER
BUILDING
Applicant Fill
Building Permit pplication 11tisid. Heavy Lines
PERMIT 670177
NUMBER
NAME (OR NAME 0
&�_ I/
94_1;_PA/
JOB ADDRESS
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Ir
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ILING jrVICEbb
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SIDE YARD
SET BACK
RBAI . YARD
CITY TELEPHONE NUMBF;R
F/T. �),;2 3
Al
USE ZONE
MAP NUMBER
VACANT SITE
0 YES NO
14AME
ITU—ILDINGAREA
LOT AREA
VARIANCE NU ��ER
ADDRESS
HEIGHT
L UILDING SETBACKS
NOTE: TO E'AVE LINES
CITY 11 —TELEPHONE NUMBER
REMARKS
NAME
`ADDRESS
.3 &
Encroachment Permit PERMIT NUMBER STREET GRADE CHECK
Required Z
n YES 0 NO W
CITY I
TELEPHONE NUMBEMR
METER SIZE SERVICE SIZE CLEARANCE BY
1-4:f (!��
I N11 ,� —e 4� !7
ICHECKED
I
STAWN LICENSE NUMBEA
LICEN13E NUMIJNK
REMARKS
LOT
BLOCK TRACT
TYPE CONNECTION VERIFIED BY
PERC. TEST PERMIT NUMBER I
PE Or CONSTRUCTION STREET IMPROVED
YES 0 NO
SPECIAL INSPECTOR REQUIRED
YES NO
OCCUPANCY GROUP
PLAN
CHECKE BY
02
WORK TO BE DONE
NO. OF BLOGS.
PERIBLOG.
TOTAL FEE
BUILDING
VALUATION
BUILDI qG PERMIT
2
FEE
DNEW
R DEMOLISH
NUMBER OF ST IE
_�LUTIBING
I
3
PERMIT FEE
ADD
4
HEAT &-GAS LINE
PERMIT FEE
QALTER
REPAIR
M RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
-3 ta
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duly author- ATTENTION
APPLICATION APPROVAL
Ized agent of the owner. I agree to comply with city and state laws regu- THIS rEnAuT
This application Is not a permit until
lating construction; and In doing the work authorized thereby, no person AUTIIOIUZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
NT INSPECTION
810147URE Ow GE DATEPIGNEL/ DEPARTMENT
Max I CITY OF
EDMONDS
DIRECIORIS SIGNATIJRE
DATE
HEQK�fPROVED
Pit 6.1107
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