650091.pdfL
ilk
1C.
Z
ig Permit
OR NAMey
G ADDRESS
.1
I
Applicant
Inside Heav,
I
uc'
5
NEW DEMOLISH
ADD I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RES] UNITS I
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-
Ized agent of the owner. I agree to comply with city and state laws regu-
IjLting construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Cade of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
CHECK &
FILE
Wj
YES III NO
[3 YES [3 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
REAT & GAS LINE
4
PERMIT FEE
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
BUILDING
PER141T
NUMBER
650091
REAR YARD
MBER
VACANT SITE
0 YES [3 NO 0
VAMANUN vujhdtl�
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
13 YES 13 NO
j
APPLICATION APPROVAL
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.
"I
�111214 1
;::o:
L ."
�N
rl
,-,...1PPLI0ATI0N BUILDING PERMIT Appl. No.
§.;Uii.%F1rl.�irMWMONDS Building Deparhnent Permit limit
one year
CATION, is hereby made for a permit to construct the following work, in accordance with the-acico�m,�
g:plans and specifications. Two sets are submitted herewith for approval.
new alter off'st.
....... Parking ......... - .. .........
k.-.'addft-� repair .............. ............................................................................
Use zone ...... e::74.4.. Fire zone ...........................
Const. type ...............................
CY ...............................
. ..... 1. Lot . ............
- .. Blk ........................ Addn ......................................
.............
........ Area ............................................ Septic. tank. ............................................. . ......... .
...............................
1� L
�Bidg" set+
e ............................. rear ...............................
acks fronL ........................... r. side ........................ .. . I. sid
own
e .................
............... Address .... .. el. No.25E::� .77
er----------- .. . ...... . ..........
Address.. ..................... Tel. No .......................
'Builder ............. . ......... .............................
............................. . ........... ..
Plans by ................ ................... Address .................................................... Tel. No .............................
..............................
...............................
Remarksx5m��. j� ....... r ....
The above is a correct statement, and I agree to comply with all applicable Codes and State laws Fegulatin
work.
Signed Owner/Agent..2� ... .. . ........ &.rzk. Address ............................................
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap,,
proved plans and specifications, and Building Department notations thereon.
Valuation d. by../�!...
Rec .... ..
. ............ ?4� .... ............. Permit fee ...... ........
.......... ... . ........ ... Date. ........ q . ..........................
Building 'Department, By...
RECORD
INSPECTION ...... ..
J 7;`1
Fdn, OK ............................................ Frame� OK ............ ........................................ Final, OY . .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
7 i'