22627 76TH AVE W.pdfd,Z0731' APPLICATI(.M &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. Ground Area .................................... NO- Stories ....... )
.... Height .... 1.7 ..........
. .................................. Const. Type...."
��'jar� Submitted ...........................................
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CATION — Address .... ......... Use Zone..e::(R Fire Zone ...
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�s ....................... . ..................... Sewerage .... ............... . ..............
t ................... 10CIL .......... Add'n ..........
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...................... Sides ..............................
re& 41,24P ........... Width ... /12� ......... Min. Bldg. setbacks, Front and Rear .......... .
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The above is a correct statemen an e to cOC all applicable Codes and State Laws regulating the work.
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L Address ............................................................................ Datel .... . ...... ... ...
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Signed: owner/Agent ...... ..... ........... ...
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.
VA-LUATION PERN[IT FEES
1 6�9�
Bldg. .... $ ...... z ....................
$ ......... .. ... .....
Plbg . .... $ ............. 6/5: .... k?::� .....
APPROVED: Heat .... $ ........................................
Elect..... $ ........................................
Date .............. ...........................
Others ... $ ............................
BUILDING DE RTMENT Urlivan Dyk, Bldg. Official
7-4 TOTAL FE
. ......... ............... E $ ....
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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RECORD OF INSPECTIONS
Date Passed
'Foundation
Plumbing (Partiil)
(Rough)
Frame
FUrnace & Fuel Lines
Final