650230.pdfding Permit Application j,,.A.JIF'.eX,"LTnes
Lq (OR NAME OF BUSINESS)
REF N� Vj F— c
LING "DRESS
914W 7sop'"6
r TELEPHONE NUMBER
�EFP/v 49XI40S 1
4�� r—!: / F—�
PERMIT
6502,
NUMBER
3DRESS
6
'e
a:5i�
!CARD' 60'
ACK
REAR YARD
ZONE
MAP NUMBER
VACANT SM
0 YES
PING AREA
LOT AREA
VMANCE P
IT
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
7-
Required
a W- � ! W- 011 7R WE MMi -� NI
NO
SPECIAL INSPECTOR Ft
0 YES [] NO
I PLAN CHECKED By
TO BE DONE
BUILDING
VALUATION
bv'4L-dt�--e Po/ecd'74 BUILDING PERMIT
NUMBER OF STORIE '32 FEE
P
P
1
L
RIES 2
8
NEW DEMOLISH PLUMBING
3 PERMIT FEE
ADD HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF It PERMIT FEE
DWELLING DEMOLITION
REPAIR NON-RESIDENTIAL UNITS 5 PERMIT FEE
PROPOSED USE
6 AMOUNT DUE
I hereby acknowledge that I have read this application; that the In- ATTENTION
formation given Is correct; and that I am the owner, or the duly author -
a regu-
ized agent of the owner. I ggroe to comply with city and state law ljh THIS rERNUT
In,
son
lating construction; and in doing the work authorized thereby, no per AUTHORIZES
will be employed in violation of the Labor Code of the State of Washing�toa ONLY THE
relating to WorkmerVa Compensation Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
DATE SIGNED INSPECTION
411-2 DEPARTMENT
CITY OF
EDMONDS
tUT PLAN CHECK & AFFkCUvZv rR 0-1107
FILE
13 YES
Cyr
4-9—V
APPLICATION APPROVAL
This application Is not a pernlit until
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
DIREC OWS.077
R's
TE J;
APPLICATI M & WORK PERMIT
Application No.
CITY OF EDMONDS Building Department Permit Limit, one Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORK — New/Addn.
......... . ........................................................ Ground Area. ................................... No. stories ............ .
PlansSubmitted .......................................................................................................... Const. Type ........................................ Height. .......................
...... Use Zone..e �2e,.... Fire Zone ....................
LOCATION — Address ... 5 a-.
..... . .. 17! ............ ...... t ...................
4401
C) e7 r�e..
Add'n../,/W.7. S
Recorded Lol5�.2i.Jr.4A Block .....
1-42
Lot Area':0 .......... Width ....... ........... Min. Bldg. Setbacks, Front CfAb .... ..... d ...
Owner ... ................... Address ..... 4;1.�� .... r:Kf . ......... Phone .................... . . . .......
Phone....................... . .......
Plans by ............................................................................................ Address ........................................................................
Bldg. by ... .......................................... Address ........................................................................ Phone .................................
PIbg. by ............. * ............................................................................. Add ess ........................................................................ Phone ................................
Heatingby ............................................................ . ........... .. .... ........................................................................ Phone ................................
................ T .. ........ . .... ..... ddress ........................................................................ Phone ...... ..................
Elect. by ............................ ........
Remarks.4 . . . ..... ....... .......................... ...........................................................................................................................
f
.................. ................ ........... ................... .....
................ V
X-) ... .. . ..... ...........................
.......... . . ...... ........ ...... ... ... ....... ............
...............................................
-.1 .......... 6 . ..... ........................................
........................ ... .................................... .. 44�,) ...........................................................
The above is a correct statement and I agree to comply with all applicable Codes and State laws regulating the work.
.............
... 7....
............ S/3- ;&/ I -
Signed: Owner/Agenl.A .. lc--�. ... 11(Z ............. Address.,94-7. x< ..... . ..... Date . .................. I
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 PERYM IMES
$ ..... ....................... 'Bldg . . . . . $ ...............
PIbg. $ ........................................
Heat . . . . $ ........................................
APPROVED:
Date.......... .. ............................... Elect. $ ........................................
BUILDING DEPARTMENT Others . . . ......................
.WM Herbert., B ................ TOTAL FEE $
By................................... ......................................
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.
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