19729 82ND PL W (3).pdfAPPLIr &WORK P
Q., 1( ERM(� (A No . ......................
pplication ......
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-Apecifications:
ifted.............. I .......................
Address
.... Ground Area ................................... No. Stories ............
---- Z�7�
Const. Type ... ............................ Height ........................
CV Z.
.................................................................
Use
Fire
........
Block .
................... ................... . ..................... sewerage..-.-i ............
W!J,
...........
Width ....... 7 ../ ........
Min. Bldg. Setbacks, Front and Re .............. ...........
Sides..,,::�L� .... .......
I �0-
a
Phone
......................................................................................
Address ........................................................................
................................
:1�1� �
4
Phone
Ul,�
....... .
............................................................................ ....
Address ........................................................................
................................
Phone
...................................................................
Address ........................................................................
................................
Heatingby ....................................................................................... Address ........................................................................ Pnone ................................
'Elect. by ........................................................................................... Address ........................................................................ Phone ................................
Remarks
The above is a correct statement and I agr.ee to comply with all applicable Codes and State Laws regulating tAh work.
I
signed: Owner/,
PERMIT for theabove work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMT FEES
$Z 0 Bldg.
..........................
Plbg . .... ..........
APPROVED: Heat .... $ ......... 6 ....... O-Z) ..........
. .........
Date .... 1�2 . )L .. ........................ Elect. $ ........................................
.... ..... .... ......
BUILDINGrARTMENT Others ... $ ........................................
&- -z�, - ----- 7)
By . ............. ew I TOTAL FEE $ ...... 6 ... C ..........
. ................................... .................
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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