23513 76TH AVE W (2).pdfE
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ORK PERMIT
APPLfCATI( A- & W Application No. 37.zK:._--6
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby ads for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
New/Addn ................................... Ground Area ........................ ....... ... NO. Stories ............
WORK ...... d.:�e
Ty......... ........ Height .......................
FireZone ....................
Plans Submitted ............................... . ......... ............................................... ........ Const. pe ......
Address ..... ..... . se zone . .. �_f..
...... .... .........
LOCATION
Recorded Lot../ ............ 11 ...... d sewerage ................................
&. 44P
LotArea .......................... .............. Width, ............................ Min. Bldg. Setbacks, Front and Rear ................................ Sides ............. ......... . ...
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Address. .........
Owner ....... ...... Phone./
........................................................................ Phone ...............................
Plans by ............................................. . ..... ..... . ... Address
BIdg. by . ............... ; ......... ......... . ................. I ....... . ................. Address ............................. . ... .................................... Phone .................... . ..........
Plbg. by .......................................... . .......................... .................... Address ............................................ . .. ....................... Phone ....................... . .......
Heatingby ..................................................................... . ................ Address ... . . . ........ I ........................................................ Phone ............................. . .
Elect. 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.
Signed: Owner/Agent .... ............. Address ............................................................................ Date...
............ 7�-i . ......
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 PERMIT FEES
0
$ . . .... ..... Bldg. $ .. ................................
APPROVED:
PIbg. . . . . $ ........................................
Heat . . . .
Date ........ ........................................
Y/ I 2� 1� 3 Elect. ........................................
BUILDING DEPARTMENT Others ... $ ........................................
Wm., Herbert,,.B TOTAL FEE ..................
By................................. : ... .... Al. -P ...................
NOTES: No work requiring Building Department or City Engineer's Inspection shall be covered before lnspe�Aion and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer piior to construction of all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
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