650342.pdfj9kLD
DEPARTMENT
APPLICATION
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Applicant Fill
Inside Heavy Lines
16106 T_
NEW
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E]SIGN
NUW
HER OF STORIES
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A
ADD
DEMOLISH
FENCE
ALTER
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Ej RESIDENTIAL
=fH OF
REPAIR
FA NON-RESIDENTIAL
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
relating to Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Umit One Year be completed In ninety days.)
OR AGENT) DATE SIGNID
c.
NOTE: Applicant Subject to Plan Check Fee
This Permit caVen work to be done on private property ONLY.
Any construction on the public domain (Curb$, SideWaAks, drl%vwaym,
marquees. etc.) will require separate permission.
650342
PEPJnT
NUMBER
7(v WVC44,.� wd(04
LCK -SETBACK REAR
'ISTREET
[] YES [] NO
BUILDING
VALUATION
BUILDING PERMIT
2
FE13
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
SIGN PERMIT
5
rmm
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
2 0
V Z--BNCE NUIZOER
(:I YES E3 NO
rOTAL 919;
A 7,
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
FILE
F -
ARLJOATIO" BUILDING PERMIT Appl. No....//
— 4 2—
........... . .. . ..... ...
OF EDMONDS Building Depurhnent Permit limit, one year
CATION is hereby made for a permit to construct the following work, in accordance with the accom,
specifications. Two sets are submitted herewith for approval.
g, plans and
�ew alter
............. ....... .........
repair ...... Poalr1k, in, g. .... ..........
Use zor
t. ty e.
0 V, .. .. . . ...... Fire zone ...........................
....... .......... ...
..... Lot ........................ Blk Addn ......................................
......................................
/0
frontage ....................................... Area ........................ ....... 7 ....... Septic tank...-Y .............
01
-2
,,,,,,,"Bldg. setbacks — front ..........
.................. r. side ....... .......... 1. .............. rear .... I ... tx ...... ..............
Owner ....
............ ............. No
. ...... el .... .......... . AddresL.... ...... Tel.
Builder..-t�aee
..... 7 ............ Address ......
........... ........................... ...... �LJ-0'��e No'
Plansby .................................................................. Address ..................................................... Tel. No ..............................
Remarks ..............................
................................................................... ............................................... ....... .
................................................................................................ ................................... ...........................
....................... .........
L
............................................................................................... .................................
................................................................
this
the above is a correct statement, and I agree to comply with all applicable Codes and State'laws regulating
work'.
Signed .0
wner/A . . ....... Addressl
ger,-/�,,z/.,
PERMIT for the above work is hereby approved, subject to the above conditions, and to oDmp4ance with the ap-
proved plans and specifications, and Building Department notations thereon.
Valuation ......... ....................... Permit fee ...... .............. Reed. by....
Building )cpartment, By .......................................
.................. Date..:VZJ .... ................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
I