23138 76TH AVE W (5).pdfAPPLICATIC -4 & WORK PERMIT
Application No.
CITY OF EDMONDS Building Department Permit Llmitj One Year
APPLICATION Is hereby made for a per t to construct the following work, in accordance with the accompanying plans
and specifications:
New/Addn . .................................... .................. Ground Area .................................... No. Stories .... z....
—4--
17
Submitted.......................................................................................................... Const. Type ....... . . ...................... Height .......................
Add Use Zonelf:2::�.. Fire Zone ....................
Zr � ....... 5.1 ... �;
.............................
v,7
. .... d n ............ .... . .................................................. . ..................... Sewers e.
..... Ic
................ ............ �A 9 > .............
. ....... ..... Width ............................ Min. Bldg. Setbacks, Front and Rear./ ......... 2t ....... Sides ...... <> ............ /—..
Phone,&,�.z ... 4::: 0
. ............ .. ... ... Address.. . ....
E . ... J ... .. ...
.............. ...... Address ................................ Wr ........... ........................ Phone ...................
. . ... ................. ...... 1.,.)z . ............... . ........ Address ......... .............................................................. Phone ..................... . .........
b..................................... . ......... ........................................... Address ........................ ............................................... Phone ..................... ..........
gby ............................................... ....................................... Address ....................................................... . ............... Phone ................................
lect. by ........................................................................................... Address ............................................................ ............ Phone ................................
Remarks
The above Is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
I
Signed: Owner/
Address............................................................................
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 PERMT FEES
$ ...... Bldg. .........
37 ` -
APPROVED:
Plbg. $ .... 0 ...........................
Heat.... $ ......... �1� ............................
Date......... 1_0/ .. 1. ....... ( 00. _Z� ......................... Elect. . . . . $ ........................................
BUILDING DEPARTMENT Others ... $ ................... ........ . .
Wm., Herbert.,; Bld
31 J. — ....
By .................................. ........ ............. TOTAL FEE $..."
NOTES: No work requiring Building Department or City Engineer's Inspection shall be covered before inspection and aRproval.
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.
I
i
Subject to a road Easement for ingress andegress over and upon the South 20.00
ts Lake McAleer Five Acre
feet of Tract 16 of the above said Plat of Skelton
Tracts.
41#
RECORD OF INSPECTION9
Date Passed
Foundation
plumbing (partial)
-7::� Frame
Furnace & Fuel Lmxs—
� �7-
Final
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