660091.pdfI
UILDING DEPARTMEN
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
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TELEPHONE NUMBE
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PEPA= .660091
NUMBER
OB A
JOB ADDRESS
B5
S 1; W Y :
IDE YARD SETBACK STREET SETBACK REAR YARP SETBACK
I
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LOT AREA Brim
NO
NEW
I 1—i SIGN
ADD I
DEM001,18B.
I El FENCE
ALTER
EZ
RESIDENTIAL
IR 07
=LING
I
F�
REPAIR
I FI
NON-RESIDENTIAL
I UNITS
I hereby acknowledge that I have read this application; that th In-
formation given to correct; and that I am the owner, or the duly alor-
Ized agent of the owner. I agree to comply with city and state laws regu-
tating 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 Lilmit One Your (beExccoPmtPIDeet'endollitnlonninwethy"hda'yhaal)I
3IGNATURE (OWNER OR AVGENT DAUS luri
C f�j
04 n ail C 1 776"6
NOTE: Applicant Subject to Plan Cbeck'Fec
This Permit coven work to be dme on private property ONLY.
Any construction an the public domain (curbat sidewalkst drivewowNp
Marquesas etcj will require separate permission,
13/l/ 1)
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT I=
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
2;.j
e,e� d
YES 13 No
e_-2 49
I
APPLICATION APPROVAL
This application to not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is aclmowledged In space provided.
IDIRECTOR'S 13IGNATURN
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AP CATION J-BUILOING
PERMIT
Appl. No. f .. ... 1� ..........
ITY OF EDMONDS
Building DepaMnent
Permit limit, one year
with the accom
APP CATION is hereby made for a permit to construct the following work, in accordance
'panying plans and specifications. Two am are submitted herewith for approval.
Off'st.
newt'-� alter
....................................................................... Parking ......................
Work addn repair ............. ... ..............
:00.
Use zone.... .... Fire zone ...............
occupancy...
............
Lot .... ........... . . B I k ........ Addn
.... .. J "'-& AI&O
7ZI-ELAT-
....... ....... .. ...... ...
Septic tank�L�4�
Iot rmtage.-I . ................ .. .
.. .. . .... ..... 10��4 ...........
...............
front. ................ side..��.� .................. rear ..... 4---r ...................
set side ....... 7... g -t55 �-,
el. No ........
... Addres&:n. � . ........
...... ......... ..............................
e Address./.a��../ . .....
................... Tel. No .............................
Plansby ............................ ...................................... Address .................................
..................................................................................
Remar............................................................
work to be done
on Tiri%aLe. prop6:�ty ONLY. ..................................
.................... ..............................................................
.............. . ........ I .................
the public domain
(c-rbs, sidr;wa*1`b` .drivev.uyu,
maKqgq!�g., ............................................................... ......................
.............
.............. ..........................
_e,"separate permission.
The above is a correct statement, and I'agree to comply with all applicable Codes and State laws regulating this
work.
Signed 0wner/
Dateleq.fr-
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.
Valuation ............ -Z-16 4.f I IC� f .... 5.57 ............... Recd. by,
............. .... ... .......... Permit
..............
Building- Department, By ................................................ ...... Date.../' /-Zp� . . ........ 67� ----------- -
coluer plumbing, Sewer or Electrical installations.
This Permit does not
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