660095.pdfW
BUILDING DEPARTMEN
PERMIT APPLICATION
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Applicant FM
Inside Heavy l[Anes
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IN KROLL NAP NO.:
1 '0 16
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LOT
BUIL
11077
PERMIT
NUMBER
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TELWHONE NUMBER ( -3
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[] YES
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13 YES E3 NO
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BUILDING
VALUATION
vo 0
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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-
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BUILDING PERMIT Appl. No. —A? ............... ...
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,