660050.pdfDEPARTMEN
APPLICATION
-110
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Applicant FW
Inside Heavy Lines
YES [3 NO
1
1
BUILDING
VALUATION
ro BE DONE
2
2
BUILDING PERMIT
FEE
3
3
PLUMBING
PEnmrr PEE
4
5
HEAT & GAS LINE
PERMIT PEE
SIGN PERMIT
FEE
NEW
ADD
DEOLISH
SIGN
113 PENCE
NUMBER OF STORIIIES
6
DEMOLITION
PERMIT FEE
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
I UNITS
7
7
FEE
81 AMOUNT DUE
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- ATTENTION
ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
t the In
or
y an
awa
tating conetrution; and In doing the work authorized thereby, no person AUTHORIZES
win be employed In violation of the Labor Code of the State of Washington ONLY THE
as �
relating to Workmans Compensation Insurance. WORK NOTED
which shall
(Except Demolitions
NOTE: Permit Limit One Your be completed in ninety days.)
81GNATJRE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to P14n Cbcch Fcc PR 6-1107
This Permit coven work to be done on private property ONi7y-.—
Any construction on the public domain (curbmp sidewalks$ drivewaYst
nuLrquees, etc.) will require separate permission.
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.
7CTOWS 0 TURE
FILE
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...................................
APPL16.JON WORK PERM�,
Application No.
CITY OF EDMONDS Building Dopartment Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the in accordance with the accompanying plane
."ind specifications:
d Area ................................... No. Stories ............
WORK — New/Addn ....................................
Submitted....................................................................................... . ................. Const. Type ........................................ Helght. .......................
'1MATION — Address .........
.... . ......................
I. ......................... .......... .............. .. Use Zone .... ... Fire Zone ........... 4
Recorded Lot ........ .......... Block ...... ..... Add'n .... 2V14e.,
.......... Sewerage ....................................
Lot Area .......................... . ........... Width ........................... Min. Bldg. Setbacks, Front and Rear ......... ...... &.. Sides ........ :7.1 ......
A1011, e�z
Owner ..... Address ..... .......... Phone../
..... .... .. ......... 0-4
7 ...........
Phone
Flom by ........ . ....... ........................... .................................... Address ................................... . ................................... ................... .... . .......
.......
Bldg. by .............. ............................. ............................................. Address ....... ............................................. .................... Phone ........................ .......
Address Phone ....................... . .......
Plbg. by ...... . ................................................................................... ........................................................................
Heating by Address ..... ................................................................... Phone ....................... . .......
.......................................................................................
Elect. by ....................................................................................... ... Address ......................................................... ............... Phone ................................
Remarks................................................................................................................................................................................................ 7 ..............................
... ..................................................................
...... ................................................................................. ....................................................................................
............................................................................... ............................ ........................................................................ . ........................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
... .............................................. .. . ... . ............ .... ... . ........ .. ....... . ....... ... . ........ ... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The above is a correct statem land I agree to cc w th applicable Codes and State Laws regulating the work.
DateSigned: Owner/Agen ....... .............................................................................
PERMIT for the above work is hereby approved, suliject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUATION PFJUVM F`EE8
Bldg. .. =:-� ..................
............. . . . .
Plbg. $ ........................................
Heat . . . . $ ........................................
APPROVED:
Date ...... .................................. Elect. $ ........................................
-1/ - = ............ E�)
BUILDING DEPARTMENT Others ... $ ........................................
By.......................................... . ....................... TOTAL FEE 0-:0 ................
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 an site utilities, such as
curbs, paving, driveways, sewer, water and street connections.