660028.pdfBUILDIN6 DEPARTMENT I Applicant FM
PERMIT APPLICATION I Inside Heavy Lines
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NEW I LJ SIGN INUMIJER OF
ADD I DEME]LISH I F] FENCE I
ALTER LX RESIDENTIAL NUMBER OF,
DWELLING
REPAIR NON-RESIDENTIAL I UNITS
I hereby acknOWIX96 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 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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year 1E1c*11 "TiOlitiona which shall
be completed In nirety ckays.)
2&4 2-�t� 11-07-16,6
NOTE: APPlicant Subject to Plan Check Fee
Tide Permit covers work to be done on private Property ONLY.
Any construction on the Public domain (curbs, sidewalks, driveways,
marquess, etc.) will require. separate permission.
I
/ A/ (F) XJ
11�
E3 YES [3 NO
BUILDING
I
VALUATION
BUILDING PERN[IT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
a
PERMIT PEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
B
P=G
ATTENTION APPLICATION APPROVAL
THIS PERMIT
AUTHOIUZES This application Is not a permit until
ONLY THE signed by the Director of Building Inspec.
WORK NOTED tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space Provided.
INSPECTION
DIREC OR'S
DEPARTMENT SIGNA 00,
CITY OF DAT
EDMONDS
PH 6-1107
FILE
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47"
LU,
K UILDING PERMIT
APPUGATION &C" Appl.
CITY OF EDMONDS 110ding Department Permit limit, one year
1p� he accom
APPUCATION is hereby made for a permit tDconstruct the following work, in accordance with t
panying plans and specifications. Two sets are submitted herewith for approval.
Off'st.
new alter
Work addn rep
......... Parking ......................
air
�,'Occupancy ................................ Const. type ............................... t Use Fire zone ......
.....................
J.... ............................. Z. Lot ........ .15E ...... Blk ........................ Addn ...................................... .
4.rea ........................................... . 9e
Lot'frontage ........................................ A :ptic .. ...... �. ........................ .
//0
Bldg. setbacks front ............. rear .. C7..,-z ............
......... .. r. side .... 7 .......... ...... /-
Own . ..... .. . . ......
J�. fo(
et....... ................................... Address., ............ . .......
Bu r . ..... NAY
Pz-.-r,.f... Addrem ....
7- 7 10/.Tel.
.. A ...............
e
Plans by ........................................................... ....................... Tel. No .............................
...... Address .............................
...... ............. .............................. .....
ThT
a perml*-E—do—v ... dr, ... ........... .......................................
q on private property ONLY.
...................
*Any ... —fli ... **p—u-b—la—c .... d*, o- m- * a** i—n, ......
on on e
(curbs, eldewalho, driveways, marquees,
.................... ..................................................................................
The above is a correct statement, and
I agree to comply with all applicable Codes and State laws regulating 'this''
work.
............... Date/ ......... J
Signed Owner/Agent.. .. ................ Address...-4;�k.. �.. .....
PERMIT for the above work is hereby approved, subject to the above conditions, and tDcompliance with the ap,
plans and specifications, and Building Department notations thereon.
proved
Valuation .................. .................. Permit fee. .... 9 ...................
Reod. by ....... ... . ... ...
..........
. .................. Date....-OA.0 . . ..... /. -� . ,
Building Department, By ...................................... . ....
This Permit does not cover Plumbing, Sewer or Electrical installations.
71
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