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PL N FILE NUMBER BUILDING
PERMIT 650041
ant
ApplIcarit
.�,,.Building Permit Applicationi in Ids Heavy Lines
e avy Lines
NUMBER
k
NAME 0 B�S EBB)
17, 7,
I.,� ." .. . I " �z
JOB ADDRESS
JO,
— 3,Ly 'ZK-d I
. If 1
�VAIIJNG ADDRESS
-
SIDE YARD SET BACK REAR YARD
all
sc.
I TELEPHONE NUMBkR
M7
U SITE
USE ZONE rquw�mn T
,orry
7�7 1 ? e, o2 716)
D YES C) NO
........ -7
'NAME
BUILDING AREA LOT AREA VARIANCE 14UNWER,
ADDRESS
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
CITY TELEPHONE NUMBER
NAMS
Encroachment Permit T NUMBER STREET GRADE CHEC
6
Required
YES NO
-CITY
TELEPHONE NUMB
METER SIZE SERVICE SIZE
CMARANCE CHECKED BY,
NUMBER
_ffTATIFL_JCENBE
CITY LICENSE NUMBER
LOT BLOCK TRACT
7 1,/ le7
TYPE CONNECTION VERIFIED BY
PERO. TEST RMT NUMBER
FIRE ZONE rRUCTION STREET IMPROVED
El YES 13 No
Z
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES NO
PLAN CHECKED BY
WORK TO BE DONE
NO. OF BLOGS.
PERIBLOG.
TOTAL PKE
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
NEW
DEMOLISH
NUMBER OF ST E
PLUMBING
I
3
PERMIT FEE
ADD
HEAT & GAS LIKE
ALTER
RESIDENTIAL
NUMBER OF
4
PERMIT FEE
5
DEMOLITION
PERMIT FEE
REPAIR
NON-REBI
DWELLING
UNITS
6
AMOUNT DUE
I hereby acknowledge that I have read this application: that the In-
ATTENTION
APPLICATION APPROVAL
formation given Is correct; and that I am the Owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws ragu-
Tma PERMIT
This application Is not a permit until
lating construction; and in doing the work authorized thereby. no person
AUTHOIUZES
signed by the Director of Building Inspec.
will be employed In violation Of the Labor Code of the State of Washington
014LY THE
tion, or his deputy; and fees are paid, and
relating to Workman's Compensation Insurance.
WORK NOTED
receipt is acknowledged In space provided.
NOTE: PERMIT LIMIT, ONE YEAR
INSPECTION
DEPARTMENT
D REC OFVS 81 RE
SIGNI�TUR3�,(OWN ER 0,9 Ap"T)
CITY OF
ATE-�
EDMONDS
LOT PLAN CHECK & APPROVED
PH 0.1107
FILE
.........
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w.
V
RPLIGUIDN
BUILDING PENIT
Appl. No.
CITY OF. EDMONDS
Building Depas hm ent
Permit limit, pneyear ,
j
APPUCAMON is hereby made for a permit to construct the following work, in accordance the accom.
j
panying plans and specifications.
Two Sets are submitted herewith for approval.
ni 1w alter
Off,st.
......... Parking ....................
Worrepair .....
....... . ..... . ...............................................
Use zone ... lm� (� ............ Fire zone ........... ...............
Occupancy; ............................... Const. type ..............................
............................. .
....... Lot ....... . ............. Blk ..... 1j.!.!9L ........ . Addn.&"t
Address ..... .......................
Lotfrontage ....................................... Area ............................................ Septic tank ........................................ I ........ ........ 7
f
front .... r.
........... r. side ........ ......... 1. side ...... Kl:�� ........... rea . ...........
Bldg. setbacks .............
N . . .. .......
Owner ..... 7n,.. ...... Address...&J=..�? Tel I Oita 6-v
dress..
uilder..
B Ad
Plansby .................................................................. Address ................................. I ................... Tel. No ........................ 7-7
...................
Remarks ..............................................................................................................................................................
V,
.............
................................................................................................ ... ........................... .................................... .
�,t, and I
agree to comply with all applicable Coder, and State, laws regul
above is a correct state,
The
work.
51 ddr .... Date ..............
�g
Signed Owner/A
I