650112.pdfP,
."'INIng Permit Applica"01
NAME (OR NAME OF BUSINESS)
Ted Ko Eckstromm
XULING ADDRESS
,'��20904 74th West
e
PR 6-4956
FIR
Associated.Htg, & Air Condo Co, Inc*
,:;1-4v -70 C/-
C
PERMIT
NUMBER
0 YES
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
13 NO
1,
ADDRESS Enerombment Permit PERMIT NUMBER WrAzzly VJH;.&V&J V7
Required a
316 Westlake North M YES rl NO I I
Seattle
Elm
MA 3-1252
297
, ljob: 20904 741th 'Jest, Edmonds
conversion to �:as heat
NEW
DEMOLISH
ADD
FX]
ALTER
RESIDENTIAL,
R OF
REPAIR
F""I NON-RESIDENTIAL
WOLE
UNITS NG
F"""I
I hereby acknowledge that I have read this application; that the In-
forninuon given to 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-
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen?a Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
UF"eo
FILE
13 YES [3 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6 1 AMOUNT DUE
ATMNTION
THISPERMT
AUTHORIZES
ONLY THE
WORK NOTED
TE SIGNED
INSPECTION
'5
4/5/0
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
0 YES 0 NO
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 aclmowledged in space provided.
1--""
A!
APPLICATI(L.94 & WORK PERMIT C.
CITY OF EDMONDS Building Department
Application No.
Permit Limit, One Year
XVICIN I Is hereby made for a mi constru�t the foll g work, in accordance with the accompanying plans
................................... No. Stories ............
...........
............ .. ..... : .................................. Ground Arse
ILted................. .............................. ....... .......................... Const. Type ... * ...................... Height .......................
RON — Ad ..... ........................ y Fire Zone ...... 3 .....
..... . ........ Use Zond.K..-.� . .. ....
*:240 1-t4z
................... B1001L ................... Add'n ............................... .......................................... . ..................... Sewerage ..........................
............. Width....,e�.Q .............. Min. Bldg. Setbacks, Front and Rear .. /k.A ....... I . .. ........ Sides 14 .. .....
............ Z? ..... 2 .....................
A ...... Phone�6
.................. 6 /12�4 W
"4 .......
.................. Phone ........................ .......
6,* plias by ......................... Address ................................... ..................
........ . ................................................
Address........................................................................ Phone ........................ .......
y ... . .......................................................................................
by...................................................................................... .... Address ........................................................................ Phone ................................
A
.................................................................... Phone ................................
,,Heating by ....................................................................................... Address....
............................ Address ........................................................................ Phone ................................
Elect. by .............. ....................... ......................
Remarks....... ..................................................................................................................... ...............................................................................................
. ..................................................
......................................................................................................................................................................................... .......
.................................................................................................................................................................................................................................................
............................................................................................................................................................................................................ .... . . I .........................
The above is a correct statement and I agree to comply with all applicable Codes and State Laws regulating,the work,
...... z ......... aL_ Address ........................................................ Date .... el.
Signed: OwnerMwz�--Rv ............ ....... .....................
V
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 PERN" FEES
&,9 ............... Bldg. ................
Plbg. $ ........................................
APPROVED: ........................................
Date.................... ........................ Elect ..... $ .........................................
BUILDING D)RyARThIENT Others ... $ ............................
By.q!�� ......... PC .................................. TOTAL FEE $ ........................................
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.