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L�sit It APPLI4...TION & WORD PER11�r1' x
Application No..
CITY OF EDMONDS Building Department lrnermit Limit,ono Year
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f� +APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plane
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WORK —New/Addn...........�F.:E...-�F;�.�........................:...J.....,...................:... Ground Area................................... No. Stories,,,.,..,. � ,
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/ Rik -PI Submitted ............. ........................ ................ ......................... »......I .......... Const• Type..•.•............................Height• ... ', :(
LOOATION Address lf.�l 5.4�!r7?t:� ...!":�..�rd�::f.~/.1....... Use Zone`'.... .....• Fire Zone...•:•
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i? , , Recorded Lot. ._• BIgCk. r� ... A,d�n..9.'..:...:.......-..........,+..�.:................ ....... Sewerago................:..... ....... 3
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Lot Area.•..:...•• .............................. Width............................ Min, Bldg, Setbacks, Front and Rear........ ............... Sides
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y'+,, Owner.... ....F.�J.............. Y !fie%Cl..............:.....:'` °"�- e
Planaby .......... Address............•...••.•..•.••.••_.................................. Phone j! ^
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ti'' ' Bldg. by.: C��d {� Address... .......... Phone �1... J
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; y++, 1 Plbg by .................... Address................................... ......... .... Phone
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Heatingby.. ................................................... dress........ ....................... Phone i ;
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Elect by......., ..: ... ...... ..................•..................••... Address...................... ............. .........Phone' I r t
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The above 1s a correct st/aft/em t and I agree to com ly with all applicable Codes and State Laws regulating the work. ;
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Signed: Owner/Agent.. �!lv r•• r .. Date ......`..
.•. Address......
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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• t1 11 ;? '
VALUATION
PERMIT FEES r' ; ` 1
$ ?` .1t: L� It Bldg. • .. • $..1.•zi..i4r.Q.. t, �,
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Plbg• • • . $....1""..... 11......... i,
APPROVED: Heat • ... $.......•......•. ... .... ..... }`' 1
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Date.: ....:. �,/ . .�.'.'.....•••!l;.7 ......................... Elect .... $....�._ ............0.......... � .
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BUILDING DEPARTMENT Others
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By........_...... ...� ... .............................. TOTAL FEE $1.�.1... Q...........
NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval: I.
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Twenty -Pour (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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__OF IN_,PCCTIONS°
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U,te Passecj 11-do
Foundation —' )..}t .i "1 { 4
_ _ Ptumtjing (Partial) tin '`.�
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Frame -_ _` 6,,
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Furnace &, Fuel Lines_�1
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