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640216.pdf_---------- ------- Lin Buildina Permit Application I .gk1PT',,can,"1,, NAME Cd 7AU CITY' NAME ADd CITY Z� NAMI 41 CITY I J� SA; R ( � 17 Kf 0 C/ (ft W�-Zf 1 LICENSE NUMBER 3 -401- Ity,91k(>40 0 Ae " ?- fs�o A� V eA2 `0 0 <1�0 [OPHONP, NUMBER 19 _,� (e f—f— 7 Required [I YES 0 NO METER SIZE I SEI 0 YES EST .7 [] Na BUILDING PERMIT f�402. 16 NUMBER SET BACK REAR YARD MAP NUMBER VACANT SITE YES 13 NO LOT AREA VARIANCE NUAIISNIt ;k ALL BUILDING SETBACKS NOTE: TO EAVIE LINES 70 STREET IMPROVI 0 YES 0 ITO WORK TO BF. DONE NO. OF BLOCS. PERIBLOO. TOTAL FK9 Z 0 BUILDING VALUATION 3- 2 BUILDING PERMT FEE _M7N_EW 1:1 ADD DEMOLISH NUMBER OF STORIES — -0/ eil 3 PLUMBING PERMIT FEE (0 0-0 HEAT & GAS LINE PERMIT FEE ALTER REPAIR Ln RESIDENTIAL NO] 1 NUMBER OF 4 DWELLING — UNITS 5 DEMOLITION PERMIT FEE AMOUNT DUE PROPO 6 JI/ I hereby acRowledge that I have read this application; that the In- formation given Is correct; and that I am the owner, or the duly author- ATTENTION APPLICATION APPROVAL ized agent of the owner. I agree to comply with city and state laws regu- lating construction; and In doing the work authorizid thereby, no person will be employed in violation of the Labor Code of tlui State of Washington relating to Workmen's Compensation Insurance. NOTE: PERMIT LIMIT ONE YEAR TIUS rERMIT AUTHORIZES ONLY THE WORK NOTED This application is not a permit until signed by the Director of Building Inspec- tion, or his deputy; and fees are paid, and receipt is acknowledged In space provided. -1 - IIGNATUI (OWNER 0 AGJENI DATE NED S 7 N _,�"PPROVED I 77. INSPECTION DEPARTM ENT CITY 0 F rn 6.1107 DIRECTO SIGNATURE DATE 01VIA i APPLICATI N & WORK PERMIT ( .A, pplication No. :�/.:v 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 .... z Plans Submitted ........... 144 ........................................................................................ Const. Type..��� ................. Height ....................... q;.,KJ LOCATION — Avress ..................................... Use Zone.��?�.�Ire Zone .... . .......... Sewerage ............... .............. Add'n ............................... ....................................... .... ........ ..... Recorded Lot.... Blol/. ... . ................... ....... ........... Lot Are a .................................. .......... Min. ............. ITS�X V ...... Width ..... t.. Bldg. Setbacks, Front and Rear.,P-.S ...... ....... Sides.... Owner..Z� �..' . ..... P �.Ic ... ... ........... .................. Address2ZI -Z.2��'7.lgf .. .. .......... 4.! ... ........ VAPlans by.,&;.w ...... Address ........................................................................ Phone ................................ . . ........ ............... ....... .......... Bldg. Plbg. by ........................................................................................... 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. 4 Signed: Owner/Agen .. .. ....................... ................................... Address ............................................................................ Date .... . .. 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 Bldg.$ ..... $ .... 6:7.1 ................... 5t Plbg. .... $ ..... ...................... APPROVED: Heat .... $ ........... �A ....................... ............................ Elect. ........................................ Date ......... BUILDING DEPARTMENT Others ... $ ........................................ ft., Herbert,, By........................................... ............. TOTAL FEE $ ..... 7 ..... 7 ....... ..... 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.