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660095.pdfW BUILDING DEPARTMEN PERMIT APPLICATION NA3n= (OR N SINEBIS) A 03�:_ULLWAFaKd&1111 sm, 1, 1 6 1 ;4 ; ji 11 4 �' — 5 Applicant FM Inside Heavy l[Anes J­t ). 0 IN KROLL NAP NO.: 1 '0 16 XBB rD SETBACK STRE LOT BUIL 11077 PERMIT NUMBER 1ACK REAR YA i I / � _� / rA MARKS Z /YZ Uzdlk METE?. SIZE SERVICE RIZE CLEARANCE CHAWD LSX TELWHONE NUMBER ( -3 : ZEE *tl OV C* or [] YES _2r_� No 10 iffm I 13 YES E3 NO 4 I BUILDING VALUATION vo 0 Z WORK TO BE DONE 2 2 3 3 BUILDING PERMIT FEE PLUMBING PERMIT FEE 5 11 HEAT & GAS LINE PERMIT FEE NEW ADD D DEMOLISH SIGN FENCE RIES UMBER OF STOI SIGN . PERMIT FEE DEMOLITION PERMIT FEE ALTER REPAIR B---RESIDENTLAL NON-RESIDENTIAL NUMBER 01P DWELLING UNITS 7 71 PLAN CHECK FEE 8 AMOUNT DUEX,._od�7_PCe� 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 "a of the State Of Washington relating to WorkmeWs Compensation Insurance. (Except Demolitions which shall NOT ermitUmitOnO Y90F; be completed In ninety days.) Ito TU (OWNE OR A ��N_T)_ I AATE SIGNED NT 4 Z ATI!ENTION THIS PERMIT AUTHORIZES ONLY THE WORK NOTED INSPECTION DEPARTMENT CITY OF EDMONDS 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. DIRECTOR'S SIGNATU DATE NOTE: Applicant Subject to Plan Cbeck Fee PR 6-1107 This P nit coven work to be done on private PrOPOnY or4jull. Any construction on the public domain (curbs, sidewaWn, driveways, msrqUee%. eje.) will require separate Pern'198IOn- FILE I A If I rd I t4 -l't t' �V I ot ....... .. I I j.Q I L 14 11 1p L. I .... 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S Building ftparhnent Permit limit, one year accordance with the accom, ON is hereby made for a permit to construct the following work, in .......... . g'�044 and specifications. Two sets are submitted herewith for approvaL Off -St. new i..,` alter ...................... addnrepair ......................................................................................... Parking ... ............... se zone ....... f." Fire zone ........ ancy ..... .......... Const. type ................................ U ....................... Addn ...................................... dress ....... Ci ................... ............. Iot ........................ Blk. ... .................... *Jp. X.. ll.o.. Area ........................................... Septic tank ......... frontage .......... ..... ..... ...... ..... Iside ....................... rear ............................... )Bldgj backs front ............ r. side ............................. 77s ..... Tel. No .............. .............. ..... ............. ................ �7 ss, ........ . Address. ................................................... Tel. No ..... ....................... P, Address .................................................... Tel. No ........................... .............. ...................................... am Y! ............................................................ Remarks ................................................................. ..................................................... .......... .................................................... ..... .... . . .............. B-0... ................................... ....... ................. . .......... ...................................................................................... ................................................................................................ ....... The above is a correct staternent, and I agree to comply with all applicable Codes and state laws regulating this work. ...................... Address ............................................ Date ... ........ Signed Owner/Agent ..... PERMIT for the above work is hereby approved, subject tDthe above conditions, and to compliance with the ap, proved plans and specifications, and Building Department notations thereon. Valuation ....... 16 .. 45rZeMin ................ Permit fee ....... S-/ ................. Reed. by ...... Building Department, By ............................... 11('0114 1 -------------------------- Date ...... .................................. 7. This Permit does not cover Plumbing, Sewer or Electrical installdtiOns,