660125.pdfBUILDING DEPARTMENT
Applicant MR
PERMIT APPLICA1 Inside Heavy Lines
(OR NAME OF BUSINESS)
MAILING ADDRESS Ilk
10-0.7 _11P So.
IN KROLL MAP NO.: BUILDING
PEBM T 660125
NUMBER
LD SETBACK I STREET SETBACK I REAR YARD SETBACK I
TELEPHONE NUMBER
iOA3 y '71'70
YES El NO
0
HEIGHT
BUILD ING AREA
VARXANCEI NUMBER
PLOT PLAN APPROVED
ADDRESS
REMARKS
CITY TELEPHONE NUMBER
NAMM
ADDRESS
REMARKS
Its
METER SIZE BERV10E SIZE CLEARANCE CHECK 13Y
CITY TELEPHONE NU�M
STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
PERO. TEST
PERM]IT NUMB ER
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
[] YES E3 NO
SPECULL INSPECTOR REQUIRED
YES [j NO
OCCUPANCY GROUP
PLAN CHECKED BY
VALUATION
TOTAL FKK
BUILDING
VALUATION
WORK TO BE DONE
C C_j
2
BUILDING PERMIT
FEE
0
3
PLUMBING
PERMIT FEE
BEAT & GAS LINE
QEl El SIGN NUMBER UP —STORIBE
4
PERMIT FEE
SIGN PERMIT
NDWD DEMOLISH FENCE
FEE
DEMOLITION
PERMIT FEE
ElALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
7
PLAN CHECK
FEE
PROPOSED Unt;
—
6�e Lo I L,
8
AMOUNT DUE
ATMNTI[ON
APPLICATION APPROVAL
1 hereby acknowledge that I have read this application; that the In-
formaUon given to correct; and that I am the owner, or the duly 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 "a of the State of Washington
relatIng to Workmen's Compensation Insurance.
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
llxl,pl Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
receipt Is aclmowledged In space provided.
SIGNATURE (OWNER OR AGENT) DATESIGNE
INSPECTION
DEPARTMENT
CITY OF
DIRE70718 101�NAT
11q'0TE: Applicant Subject to Plan Check Fcc
ELPMONDS
PR, 6-1107
FILE
This Permit coven work to be done on, private property ONLY.
Any construction on the public domain (curbs, shlewalkso driveways,
marquess, etc.) will mquire separate permission.
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APPLICATION BUILDING PERMIT Appl. No . .......
CITY OF EDMONDS Building Department Permit limit, one year
ON is hereby made for a permit to construct the following work, in accordance with the accom-
:and specifications. Two sets are submitted herewith for approval.
Off -St.
alter
11':� repair ....................... Parking ......................
...........................................................
Fire zone ...........................
Const. type ................................ Use zone..._.7.(=. r ..........
.......................
0�;v c'
. . .... Lot ........................ Blk ........................ Addn ......................................
-e
.................................. Area ............................................ Septic tank ........ ..........
front ......... kPP./ ....... r. side .......... 0/ .............. 1. side ............ 4L" ......... rear ............
edress. FeT ............ Tel. 4z z
............ ......................
.. . ...................... Address ............................. ...................... Tel. No .............................
Address .................................................... Tel. No .............................
'97
..............................................................
i by....
Remarks................................................................................................................................
.................................. ...............................................................
................................................................... I ..........................
................................................................................................ ................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
-3—/0 'D
... ...............
Signed Owner/Agent ... 7.. Address ............................................ Dat
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.
.................. Recd
Valuation ........ /6-5 . ..................... ..... Permit fee ..... 54�
. I
Building Department, By ..................... .. . .............................. Date ..... .........................
I
This Permit does not cover Plumbing, Sewer or Electrical installations.