660187.pdfa
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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77,el- /s S- 7
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KROLL MAP NO. BUILDIN(
PERMIT
NUMBER
-41
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[3 YES
NO 0
MBER
- 11
04
10 YEB 0 NO
SPECL46L INSPEOWUlt WUIRED OCCUPANCY GROUP
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Loft-
BUILDING
VALUATION
P
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BUILDING PERMIT
FEE
44.C4-v%;�
3
PLUMBING
PERMIT FEE
4
5
HEAT & GAS LINE
PERMIT FEE
U
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NEW
ADD
DEMOLISH
SIGN
FENC
NUM ER OF STORIES
SIGN PERMIT
FEE
6
DEMOLITION
PERMIT FEE
F-I
ALTEk
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
NU ER OF
DVS�LING
UNITS
7
PLAN CHECK
FEE
PROPOSED USE
81
AMOUNT DUE/%�Ojq�
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I hereby acknowledge that I have read this application; that the In- ATTENTION APPLICATION APPROVAL
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 laws regu- THIS PERMIT This application Is not a per"t until
lating construction: and In doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONJ,Y THE signed by the Director of Building Inspee-
I hereby '
ma"on given
z agent 0, th
g 0
L'Iatin
c Us Ct
be s up yec
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elating to Workman's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
T P rl 11111PI Demolitions which shall receipt is acknowledged in space provided.
NOTE: Permit Limit One Year be completed In ninety days.)
G 0 INSPECTION DIRECTOR'S IGNAT
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
0,
CITY OF T!
*DAT
EDMONDS
NOTE: APPlicant Subject to Plan Check Fee J-R 6.1107
!Fh_j,permIt covers work to be done on private ProPcrtY ONLY.
Any construction on the public domain (curbs, sidewalks. drIvowmYs,
marquees, etc.) will mquire separate permission.
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--- --- - --- ------- . . . . . . . . . ... -
APPIJCK,,--. IN & BUILDING PERMIT
CffY OF EDMONDS Building Department
APPUCATION 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.
new Off'st.
alter .......... Parking ......................
Work addn repair ...................... ........
Occupancy. Const. type ............................... Use zone ...... C—=J� Fire zone .........................
z,-e,
Address......... �rX- �- .......... ....... .7 Blk ........................ Addn ......... ..........
Lot frontage ....................................... . LArea ......
..... 9.�.,.43.Septic tank .......... ..................
Bldg. setbac1cs front ........... r. side ............... §�../ ...... 1. side ............ 4�� ........... rear .......
.....................
—dtLAddress...
Owner...
Builder.................. ............................................. Address. ....................
Plansby .......................................
Remarks..............................................................
Address.......................................
... Tel. No .............................
Tel. No....
The above is a correct statement$ and I agree to comply with all applicable Codes and State laws regulating this
work. -7
.,3
Signed ... i V
/Address ............................................ Date ... Z
PERMIT for the above work is hereby approv4 subject to the above conditions, and to compliance with the ap,
proved plans and specifications, and Building Department notations thereon.
-Z
4 . . ........... Recd. by.-��.. .. ..... .. .....
Valuatim ....... ........... .................. Permit fee .................... ..... * .... I ..
Building Department, By ....................... e??5171 . ............. . ................... Date ...... ........ �;z . ..........................
NOTE — This pertnit does not cover plumbing, sewer, or electrical installations, nor does it pennit any work to be
done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades of streets
and alleys, and plans for future sidewalk development.
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