610346.pdfAPPUGATION & "JILDING 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 axe submitted herewith for approval.
new ✓ alterOff-St.
Work adds repair ....... 2 ........................................................... Parking ......................
Occupancy ............................... ...........Const.type......................... .. Use zone Fnz .......... Firezone ...........................
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Address./Z(2/ ..... —..-Zit ........... Lot .... .......... Blk r ......... Addri......... ......
Lot frontage ........................................ Area /.Pa. - Septic tank.... ................
,
Bldg. set -backs front--27-'�' . r. side ...Ili.................. I.
'car..
....... .....
Owner/ --:7Z .... Addres&-.e .................. Tel. No?,ek :7
Builder... ................................... Address................................................... Tel. No.........................----
Plans
o.............................
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..,.../�....—.-,��/�. .Y..�A-.Address.../., .✓. .............
PERMIT for the above work is hereby approved, subject to the above condi s, to com lance with the ap,
proved plans and specifications, and Building Department notations them
I
Valuation ............ Permit f ee ......... Rec .. . . ..........
Building Department, By ............................................... .... Date .............. . . ........ (:.; �'. / ...............
,44P. 1-1*1e /-0 417,vG RA,-YA&r,
This Permit does not cover Plumbing, Sewer or Electrical installations.
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