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NAME
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ADDRESS
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#4
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WORK TO BE DONE
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NEW I SIGN
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A ADD DEMOLISH 11:1 PENCE
It ALTER RESIDENTLALL NUM13ER OF
DWELLING;Lo
REPAIR NON-RESIDENTIAL UNITS
PROPOSED USE
--I—
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn 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 Limit One Your be completed in ninety days.)
a-Tin"ATURE (OWNER SIGNED
NOTE: Wplican&bject to Plan Cieck Fce
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
I
I _5_1
SPECIAL INSPECTOR
0 YES [3 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FE I,
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
I BUILDING
P NU"ER 650447
ERMIT
YES C3 NO
13 YES E3 NO
I I eL� I
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.
ZA
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9T- - - - - -
OATION BUILDING PBUIT Appl. No. ......
Permit limik
.�.EDMONDS Bulkling DepadmeW one year
ON is hereby made for a permit to construct the following work, in rdance with the accom-
and specifications. Two sets am submitted herewith for approval.
<�2 Off -St
repa= .......... . ....................................................... Parking ........................
...... Const. type. Use zone...
77 er' o
0
7W &— -7-W :149 -1 -IN kv zxza
............................... Lot ........................ Blk ........................ Addn ......................................
e ....................................... Area... .... .................. Septic tank....
.. . ...............................................
f r. side ......... %,'5 ...... ...... 1. side ................ 4.5 ..... rear ......... Z.4L.,4. ------
`—Ilf, Joy,
dress. ... Tel. NW9—,�z9',r7
....................
................................................... 1-X ......
........................... Address. ................................................... Tel. No .................. ..........
Bui der ............... ..........................
Plansby ................................................................. Address .................................................... Tel. No .................. I ...........
Remarks..................................................................................................................................................................................
................................................................................................ ............................................................................... ............
.......................................................................... ..................... .................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating:rthis
work.
Signed Owner/Agent ..... 1� ........................................... Datea��::��!�76/
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.
......................... Permit fee ............... A
Valuation ...... /0" .................. Reed. by ..... e�rA .......
BuildingDepartment, By ..... ................................................... Date .... .......................
This Permit does not cover Plumbing, Sewer or Electrical installations.