650244.pdfAPPLICATI( A & WORK PERMIT
Application No.2�� . . ..... 3
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 plane
and specifications:
WORK— New/Addn. ...................................................... Ground Area ................................... No. Stories ............
PlansSubmitted .......................................................................................................... Const. Type ......... _N� .. .................. Height
ddress t
LOCATION:/ ....... ....................................... Use Zone .................... Fire Zone ....................
Sewerage ...... ..................
...........
R& .................. 4oclL Add'n..J-6'5 .... ..
Lot Arcs . ....................................... WldthA, ... &/Min. Bldg. Setbacks, Front and Rear ... Z:E.-/ ............. Sides ........ 4 ........ 7
owner..... .. .. ... ... ............. ............................................ Address ... ."hone ... Z'
........................................................................ Phone ................................
Plans b ...... ... ......
y . .. ..... 7 ......... —,../ ............... Address
z/ .......................
Bldg. by .. .................... .. ... ............. 72 ... ... Address ........................................................................ Phone ................................
Plbg. by ........................................................................................... Address ........................................................................ Phone ................................
Heatingby ....................................................................................... Address ........................................................................ Phone ................................
Elect. by ........................................................................................... Address ........................................................................ Phone ................................
Remarks...............................................................................................................................................................................................................................
ji
..................................................................................................................................................................................................................................................
............................................................................. I .....................................................................................................................................................................
..................................................................................................................................................................................................................................................
The above Is a correct statement and I agree to comply with all applicable Codes and State Laws regulating the work.
Signed: Owner/Agent .... /.� s...
.................. Addres ............................... Date..
PERMIT for theabove work is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PERMIT FEES
Bldg. $ ......... -s-a
..........
APPROVED:
Plbg. $ ............ 7.4ft...
Heat .... $ ........... .
.................
Elect. ... .$ ........................................
BUILDING DEPARTMENT Others ... $ ....................... wmame9ov*e*9***** -------
ByYm- Herbert, B14.g ....... in TOTAL FEE $ ...... ......
........................................ .........
NOTES: No work requiring Buildin epartment or City Engineer's Inspection shall be covered before inspection and ap
proval.
Twenty-four requested. Contact the City Engineer prior to construction of all site utilities, such as
curbs, piving, driveways, sewer, water and street connections.