21316 84TH AVE W (3).pdfAPPLIGATIQ� & BUILDING PERMIT
Appl. 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 accom-
panying plans and specifications. Two sets are submitted herewith for approval.
new alter Off'st.
Work. addn 'r2 ......................................... Parking ......................
repair V JOICZ .'
. ... ..... ---
zone ..... ....... Fire zone ...........................
Occupancy............................... Const. type ................................ Use
Address..*� ............ Blk ........................ Addn ......................................
A 1 :1 110 (A.) . ..........
Lotfrontage ......................... r ............ Area ........................................... Septic tank ................................................
e
.,,5 ... �..O ..............
Bldg. set -backs — front ..... rJ .......... r. side ......... 11-5 -- — --------- 1. side ........ ................. rear ....
Owner ... /I(jx ... ...................... Addres& .... ..... Te ....
&024'.� ........................ Address ................. ......... ...... Tel. No .............................
Plansby .................................................................. Address .................................................... Tel. No .............................
Remarks......................................................................................................................... **-**,**,-*,* ..........
........................................................................................................................................ I ........................................................
................................................................................................ ................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent .... .... Address ............................................ Date..
PERMIT for the above work is hereby approved, subject to the above conditions, and to com pliance with the aP,
and Building Department notations thereon. /2
proved plans and specifications,
Valuation ......... ................ permit fee ......... 4 ................ Recd. by...,;r�Z i�lr
Date... ........ ...............
Building Department, By ............................ ...........
This Permit does not cover Plumbing, Sewer or Electrical i-nstallations.
---- ------
..... ..... .... .....
PPUGATION BUILDING PERMIT Appl. No. ........
OF EDMONDS Building Department Permit limit, one year
ON is hereby made for a permit to construct the following work, in accordance with the accom-
lans and specifications. Two sets are submitted herewith for approval.
Off -St.
new alter 7Z,
addn repair ............... '�o
. ..... Parking ......... . ...........
.....................................
Const. type .......... .................. Use zone.....rz-1 ....... Fire zone ...... 5 ............... -�J
L ..........................
...................... ...... . .......... B11L ..................... Add
......... ...............
Lo e.
t frontag ........ A9 A../Or.4Area ........................................... Septic tank .......... J.e�. .... ........... . .......
front ...... r. side ......... .......... rear ....... .... . .......
+
Bldg. set -backs .............
...... ............ Address ......................... ...... ............. Tel.
Owner ... 4V
Builder................. .................... Address. ................................................... Tel. No .............................
Plansby .................................................................. Address .................................................... Tel, No .............................
Remarks............................................................................................. ....................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
2 Z_
....... Address ............................................ Date..�a. 4
...............
Signed Owner/Agent&�X....._. 44 -- - ---------
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the a
proved plans and specifications, and Building Department notations thereon.
Valuation ....... ............. Permit fee ...... ................. Recd. by ........ . . .....
Building Department, By ............. url4L 1-4Z ...... ..........
........................ ................... Date .......................................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.