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640427.pdfPermit Application Hcant Fill "C App hies .S`1d1e1HcaVy L PLAN FILE NUMBER BUILDING PERMIT NUMBER 640427 NAME OF BUSINESS) JOB ADDRESS DRESS SIDE YARD 13 SET BACK REAR YARD �1 A � A YES [3 NO rZ LOT REA VARIANCE NUMBER BUILDING AXLEA HEIGHT ALL BUILDING SETBACKS I NOTE: TO EAVE LINES REMARKS LEPHONE NUMBER I+C---- A"t-PQ L _­1-N)r­ ro'd -Encroachment Pe t PERMIT NUMBER STREET GRADE CHECXI,, is Required 0 YES [3 NO rA TELEPH&��NUMBER METER SIZE SERVICE SIZE CHECKED By k NA L�7 )-- S 6 0 0 rLEARANCE UB CITY LICENSE Nu=�-K REMARKS BLOCK TRACT TYPE CONNECTION VERIFIED BY PERMIT NUMBER PERO. TEST FIRE ZONE TYPE OF CONSTRUC TION STREET IMPROVED I 13 YES [3 NO Z 0 SPECIAL INSPECTOR REQUIRED ] OCCUPANCY GROUP YES 0 NO PLAN CHECKED 13Y WORK TO BE DONE NO. OF BLDOS. PERIBLOG. TOTAL FOR BUILDING VALUATION BUILDING PERMIT A (U (_7 L_ CAT 11(!5 INUJULShat OFVORIES NEW DEMOLISH 2 FEE PLUMBING I FV1 3 PERMIT FEE ADD — 4 HEAT & GAS LINE PERMIT FEE — L NUMBER OF QALTER RESIDENTIAL 5 DEMOLITION PERMIT FEE DWELLING QREPAIR Q NO UNITS I�R_01 6 AMOUNT DUE �d AT=NTION APPLICATION APPROVAL 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 allthOr- Ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT This application is not a permit until lating construction; and In doing the work authorized thereby, no person AUTHORIZES signed by the Director of Building Inspec- will be employed In violation of the Labor Code of the State of Washington ONLY THE relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and receipt is acknowledged in space provided. NOTE: PERMIT LIMIT ONE YEAR (OWNER OR AGENT) 13AU7N SIGNED INSPECTION DIRE R1418IG DE11ARTMENT 4 �IIN41T irk V1 4yk, X CITY OF DATE EMIONDS LOT PLAN CHNUA & APPR6VED y I PR 6-1107 /1 Z ki a Film " R APPLICATI44M & WORK PERMIT ......... Application No.'�--71 N CITY OF EDMONDS Building Department Permit Limit, One Year R 0 ,A, PLICATION Is hereby made for a permit to construct the following work, in accordance with the accompanying Plans eciffea ons: Ground Area .................................... NO. Stories ............ Addn. .................. ......... ...................................................... ans Submi ..... � ...... e ......... ? ..... ..................... Const. Type ..................... Height ........................ tted ... W�.� ....... ION— Address .... ... . ......................................................... .......... Use Zone.. S.. Fire Zone .................... ed Lot .... ...... Block. ................... Add'n.&Z .. �. -..( ...... /P ....... ...................... . ..................... Sewerage ................................... ,Area ....................................... Width ............................ Min. Bldg. Setbacks, Front and Rear ................................ Sides .............................. 111�7�7a . .............. ... Address./ ....................... Owner ............... ....... ...... ......... ....................... Phone .......... ............ .............. ... ...... a . . ... ......... .... ....... . ...... Address/M� ......... Pho4P E Plans y. .......................... Phone ................................ Bldg. by ........................................................................................... Address .............................................. Address........................................................................ Phone ................................ Plbg. by ........................................................................................... 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 PERMIT FEES 00 .7 41L . ..... Bldg . .... $ . ................................... APPROVED: Date........ ........... BUILDING DEPARTMENT By--W'ffi-v.---H49r-ba PIbg. Heat.... $ ........................................ Elect. $ ........................................ Others ... $ :::::: ............................. TOTAL FEE V NOTES: No work requiring Buildin r Deptment /or' City Engineer's inspection shall be covered before inspection and approval. F. u such as Twenty-four (24) hour notice re uested. Contact the City Engineer prior to construction of all site utilities curbs, paving, driveways, sewer, water and street connections. � J