20907 83RD AVE W (3).pdfAPPLICATI� & WORK PERMIT
Application No.
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. ;�e ....... &�: ............................................. Ground Area ................................... NO, Stories ............
. ........................... Const. Type ........................................ Height. .......................
Plans Submitted ............................................
;04
'Use Zone .................... Fire Zone ......
. .........................
— Address ...... .... . .. ...
LOCATION ......
Recorded Tjpt ... 3 lock L ................. Add'n ... . ..... .... Sewerage ....................................
Lot Area ................. ...................... Width ...... o ..................... Min. Bldg. Setbacks) Front and Rear .......... o ..................... Sides ............ o .. . .............
Phone -Al -se .....
............................... Address .................................................. .... Phone ................................
Plansby .................................................. —* ... —
Bldg. by ................................................. ............................... Address ................................................. —* ... ** ... Phone ................................
Address......................................................... Phone ................................
Plbg. by ...............................................
/ 1) ........... Phone-2L;z —3:t —.00
Heating 0 . . .............. Address .... *9 ZZM�� ** . .. ... , * ................... .. ...
Address........................................................................ Phone ................................
Elect. by ................................................. ..... —**-- .... --
Remarks
The above is a correct state d I agree to comply with all applicable Codes and State Laws regulating the work.
Datel�
Signed*: Owner/Ag .... .. Address ................................................. ............. .. .......
. . . . . . . . . . . . . . . . . . . .
....................
PERMIT for the above work Is hereby approved, subject to the above conditions, and to compliance with the approved plans
hnd specifications and Building Department notations thereon. PERNaT FEES
VALUATION
$ ........................................
APPROVED:
......................
Date ..................... /21/
BUILDING DEPARTMENT
Bldg. - - - - $ ........................................
Plbg. .... * .......................................
Heat.... $ ............ ... ................
Elect. ........................................
Others........................................
01�
TOTAL FEE $ ................... :7 ..................
NOTES: No work requiring Building D artment or City Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice iquested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
I