650142.pdfBuilding
Permit Al
NAME (OR NAME OF BUSH,
Conrad B. Short
MAILING ADDRESS
Id
401 19 PL. South
CITY
FAmonds
NAME
ADDRESS
CITY
NAME
Water Heater Exc
R
ADDRESS
11447 120th NE.
CITY
8
Kirklandp Wash
STATE LICENSE NUM13EEL
Gas Pipeing
--- ---- ---
PR-"16/+
VA92-6o89
Fill PERMIT
Lines INUMBER 65014
JOB ADDRESS
I 4GI-19-pla� P/- (,k-.) -
NEW
DEMOLISH
ADD
I
ALTER
rx-1 RESIDENTIAL
NUMBER OF
I
DREPAIR
NON-RESIDENTIAL
DWELLING
I UNITS
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.
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
relaUng to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
SIGNATURE (OWNER OR AGENT) DATE SIGNED
WATER HEATER EGXHANGE 1 4-19-65
PLOT PLAN CHECK & APPROVED
FILE
0 Ims
ALL BUILDING SETBACKS
NOTE: TO E&VE LINES
Required
r-I YES
F111M,
[] YES [] NO
El YES Ej NO
BUILDING
VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE 3.00
DEMOLITION
5 PERMIT FEE
61 AMOUNT DUE 3.00
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application Is not a permit until
AUTHORIZES signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy'; and fees are paid, and
receipt is acknowledged in space provided.
INSPECTION CTOR 8 NATURE
DEPARTMENT
CITY OF r
EDMONDS D A TE 411,
I
PR 6-1107 )X,11_2
BUILDING PIERMIT Appl.
No . ..................................
NJ
APPMATION
�Cfff OF EDMONDS Building Department Permit limit, one year
0PJlJICA1nON is hereby made for a permit to construct the following work, in accordance with the accom-
ik
yin lans and specifications. Two sets are submitted herewith for approval.
g.T,�.,rpan g p
Off -St.
new alter
................
Work addn repair ............. ......................................................... ........................... Parking ......
Use zone .... . ... ........... Fire zone ...........................
Occupancy ............... Const. type ................................
--- &
0�cv-
Address............................ ............ Lot ........ ........... Blk ........................ AddC
.....................................
Lot frontage ........................................ Area ........................................... Septic tank ......... "__
..................
Bldg. set,backs front ......... ......... r. side ............................. 1. side ........... .............. rear .............
.........................................
Owne Address. ...... .... Tel. No..4=v57.!!.f
X ............
...... ....................
Builder................................................................... Address. ................................................... Tel. No .............................
Plansby .................................................................. Address .................................................... Tel. No .............................
Remarks..................................................................................................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent ...... 14 ----- �- ddress ............................................ Dat6...
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 imit fee ...... ��/ ............... Recd. by .......... ...............
e ......................... Pe
BuildingDepartment, By .......................................................................... Date .......................................
INSPECTION RECORD
Fdn, OK ............................................ Frame, OK .................................................... Final, OK .........................................
This Permit does not cover Plumbing, Sewer or Electrical installations.