640136.pdf.... .... ...... .
11
Applic,
Ing Permit Applicationj Inside He
NAME OF BUSINESS)
C�
6) "ro-r , -C - 00
A %
�NAME
�Ie
ADDRESS
XI-P
CITY
A
STATE LICENSE NUMBER
LOT BLOCK TRACT
Flu
PLAN FILE NUMBER BUILDING
PERMIT
NUMBER 640136
3 1/ -
-- z1 '(6 �xa-4
REMARKS
5�� e'-
Encroachment Permit PE
Required I
SPECIAL INSPECTOR 11
0 YES [3 NO
PLAN CHECKED BY
WORK TO BE DONE
#d:!!5Pf C:P .401�:'9:�710ek<=4e S' 0 rV Z04 '0 4'
BUILDING
1
VALUATION
1
'0
.,q
T
Pg
BUILDING P T
NUM13ER OF STORIES
NEW DEMOLISH
2
FEE
PLUMBING
ADD I
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
1:1 ALTER I El RESIDENTIA.L "=R OF
D ELNG
REPAIR NON-RESIDENTIAL I UNITS
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
ATMNTION
I hereby acknowledge that I have read this application: that the In-
formation given in correct; and that I am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and state laws regu-
Tills PERMIT
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
S NATURE ENTI DATE SIGNED
(OWNER OR AG
5/0 5--/
INSPECTION
DEPARTMENT
CITY OF
APPROVED
77aN O-n�*
I "ZI dONDS
6.1107
FILE
I
4
�R YARD
1 E3 YES
VARIA
�L BUILDII G 8
TAVE 9ES
0 YES
[3 NO
UMBER 14
E CHECK
04
PROVED
13 NO
&L FKK
APPLICATION APPROVAL
This application Is not a pemitt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
V-//
I
''APPUCATION *AUILDING PERMIT
Appl. No.
'Peimit.limi
CITY OF EDMONDS. Buildingbe
partment ti: one vea
T qC01!
f,APPLICA ION is hereby ma& for a permit to construct the following work, 'in accordance 'thei
pahyp'g - plans and specifications. Two sets are submitted herewith for approval.
t
lo� alte Off,
new
�.W.ork 'addn repair . ............................ ............. .... Par .................
. ...................................... 7 .................
Occu ncy ..... type-...
.... . .......... . Const. .... 7:1 . ................. Use zone....-f ........... Fire zorm
76W
...... Ad
Addfess.� ................. ............. . .... ..................... Lot .......................... Blk ...... .............. dn .� ...........
r
fro Area ........
Lof nta ... Septic tank ........ ......... ......
ge. ... ............................... ... ......................
Bldg.' setobacks 'L— front ... .................. ..... r. side ............................. 1. side ......... ............ ie;er .................................
................................................ Address ... ..
................
Tel:' ......
er.. ............................................. ............ ......
;;90� 'Addre&�.? ................. ............ 1: . .....
............................................. Address"go .............
... ........ .. I .... .. ......... Tel' No ..........................
7
............ . . ......................................... 11 ... .......
�r .................................................
above ii'a 'correct statement, and Lagree to comply 4 alL.'a olicable Codes and, S�ateja 8,,re
i work.-.,
Signed Own , e , i/Age' D
nf:., ............................. ............. ...... Address .............................................. ate.
'PEWIt:: for the ab8vt' )rk is hereby approved,, subject to the above conditions, and co 11
e wc
e4 j.
C. proy,ed Plans. anc cat ions, and Building Department, notations
1. sp thereon.
4�', �Mii fie. .... Recd.,:by� ..........................
:Viluxtiori ........ ....................... .......... ...... . PL . . ...........
4'
_�IB � u ilding Department. B� ........... �V4
..................... ................. ........... ....... Da
d"!
5',
INSPECTION RECORD
AM
............... me,'
�%:, OK ......... ........... f ................ ............
dn,','OK .... .................. *. Fra ....... AFina . ...............
'Al
T is Permit does itot cover I
h ilitmbi��, gitveror'Electrical
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