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660097.pdfBUILDING DIPARTMENT Applicant Fill �1! � Inside Heavy Lines -TO—B F!PERMIT APPLICATION !7 0 13 NAME (OR NAME OF BUSINESS) 1=1D Lt, AltFJ?-- ,0 NEW " SIGN ADD I DEMMOLISII I lia FENCE ALTER M Lz—r RESIDENTIAL NUMBER OF IF-] DWELLING I REPAIR NON-RESIDENTIAL UNITS TCROLI� MAP NO.: BUILD] PERMIT NUMBER 660097 1 (:3 YES 0 NO a HEIGHT B AREA VARIANCE NUMXNn I �T ^m GT Am A ��wnvv.n I hereby acknowledge that I have read this application; that the In- formation given is correct; and that I am the owner, or the duty 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 Workmen's Compensation Insurance. (Except Demolitions which shall NOTE: Permit Mmit One Year be completed In ninety days.) IGNED 3IGNATURE (OW OR OR AGENT) DATE 8 NOTE: Applicant Sitbicct to Plan Check Fce This Permit covers work to be done on private property ONLY. Any construction on the public domain (curbs. sidewalks, driveways, marquees, etc.) %vill require separate permission. 0 YES 0 NO BUILDING I VALUATION BUILDING PERMIT 2 FEE PLUMBING 3 PERMIT FEE HEAT & GAS LINE 4 PERMIT FEE SIGN PEMUT 5 FEE DEMOLITION 6 PERMIT FEE PLAN CHECK 7 FEE S AMOUNT DUE AT=NTION THIS PERMIT AUTHORIZES ONLY TIIE WORK NOTED INSPECTION DEPARTMENT CITY OF EDMONDS PH 6-1107 [3 YES 0 No MIX Z M 4 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 aelmowledged in space provided. F1 LE I V APPLICATION BUILDING PERMIT Appl. No. CITY OF EDMONDS Building Department Permit limit, one year APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom- panying plans and specifications. Two sets are submitted herewith for approval. Off -St. new alter Parking - - ------ - ----------- Workaddn repair ...... 4� ......... ...................................................... .................................. Occupancy ................................ Const. type ................................ Use zone ..... ...... Fire zone ........ 6 .. . ......... 'f-'c 11� . le, .................. Address._'g.&�..az .... . .... . .......... ...... '. Lot ....................... Blk ........................ Addn .................... Lot frontage .......... Area............................................ Septic tank ......................................................... Bldg. set,backs front ............................ r. side ............................. 1. side .............................. rear ................................ Owner.x�'. ..... 2 z� ............................... Address .................................................... Z�l - Tel. No ............................. ,Builder ........ .......... .................... Address ................................................... Tel. No ............................. Plansby ................................................................... Address ................................................... Tel. No ............................. Remarks...................................................................................................................... The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this work. Signed Owner/ D a t e.. - V___2 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. d. by ..... A2� Valuation ...... Z.A—e-e ........................... Permit fee ........... __;;� .... Rec ...................... .... 4- Building Department, By ................ W ........................................ Date ............... .................... INSPECTION RECORD Fdn, OK ............................................ Frame, OK .................................................... Final, OY . ....................................... This Permit does not cover Plumbing, Sewer or Electrical installations.