23911 76TH AVE W.pdfko
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APPLICATI' N & WORK PERMIT
Application No.
�',CITY. OF EDMONDS Building Department Permit Limit, One Year
ereby made for a permit to construct the following work, In accordance with the accompanying plans
....................................... ............... . . ...................... . . . ............ Ground Area. ................................... No. Stories ............
':4 .. 4�. . ............................................................... . ............ Const. Type ........................................ Height ....... ........
. a.!9.z/ ................ Use Zone..e:::.,?.. Fire Zone ....................
........ .... .... ....... ........
10CIL .... ......... Add'l:'./'. Sewerage ..... .. . . ........................
......... Width..�/ ......... Min. Bldg. Setbacks, Front and Rear ................................ Sides ...................
. . . . . . . . . . . . . .
Address ... ...... _A_
. .7. ................. Phone..Z ......... ........ C..
.... ...... ........ ...................... ........................
.................... . . ... . ...................... . &ddress .............................. . ...... .. . ......... . ............... Phone ..... . .........................
Address .................................... . . .. . .......................... Phone ................................
...........................................................................................
N......
. .. ..... ..................................... Address ........................................................................ Phone ..................... . .........
Heatingby .... . ................................................................................. Address ......... . ................... .................. . ...................... 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,
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 PERAUT FEES
:��... Bldg . . . . . $ ........................................
Plbg. $ ...............
.......... I ........
APPROVED: Heat .... $ ........................................
Date......... .................................... Elect. $ ........................................
ARTMF
BUILDING DEP NT Others ... $ ........................................
Wm. Herbert,,,Bldg. Insp.
BY . . .... .............................................. ........................ TOTAL FEE $ ...........
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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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