18502 84TH AVE W (2).pdfAPPLICATI, N & WORK PERMIT 0.
Application N
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying Plans
and specifications:
WORK— New/Addn . ..... . ... .......... ................................................ Ground Area ................................... No. Stories ............
PlansSubmitted ................................................................................ ......................... Const. Type.__,.4Z.Z .................. Height ........................
i<� .................. se Zone ...... ...... zone ........
LOCATION — Address ...... ............. ..........................
Recorded Lot... Block. ................... Add'n_`05� ... . . ........ .. .... �. S� ...............
Loot Area../..T,...'�� ..... 7 . . .... Width ..... .... 2'Allin. Bldg. Setbacks, Front and Rear.�� .................... Sides.
ddress ... ........
... ;F ... ;.� .. Z-.. eflz�t . . ..................... P one.A .. .
...................................................... Phone ................................
Plans by .. e
....................... Address ..................
............................................................... Phone ................................
Bldg. by ............. ........ ..... ..................... Address .........
Plbg. by ............................................................................................ Address ........................................................................ Phone ................................
Heatingby ....................................................................................... Address ........................................................................ Phone ................................
Elect. by ........................................................................................... Address ................................... . ................................... Phone ................................
Remarks
..............................................................
................................................................. I ....................................... ........... % .. ..........................................................
--------------------
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work,
R::� ... fi ....... jDat
Signed: Own . . . ...... Address ... vif e.0
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMIT FEES
..... .. Bldg. $.��.: ... !E �. ......
APPROVED:
� 4-
Plbg .
. . . .
$ ... ..................................
Heat.
. . .
$ ......... ........................
Date .............. 1-7, Elect. $ ........................................
-Lo ......... ......................
BUILDING DEPARTMENT Others . . . $ ........................................
'4�� TOTAL FEE $ .... 7..q ... ... 5.0 ..
By........................................ . .. ................................
NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
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(ROLIgh)
Frame 2—
�l Lines i of
Furnace & FuL _0 "Ce
Final