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EPARTMENT
PLICATION
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CITY
STATE LICENSE NUMBER
Legal Descriptim of Property (Show Bell
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TO 5 0 0 17"
BEIN6 DEED VU q
WORK TO 1310 DONE
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Applicant FIR
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" SIGN
NEDWD I DEME021611 1:1 PENCE
ALTER RESIDENTIAL NUM13ER OF
DWELLING
REPAIR FA"NON UNITS
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 fitaL6 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 Worknlen's compensation Insurance.
(Except Demolitions which shall
No P!rMit Limit One Your be completed in ninety days.)
DATE BIG
F1QNjPT—h_ NER OR 7 NED
14 7T e . 6 (.
NOTE: APPlicant Siibjcct to P14n Check Fee
hda Permit coven work to be done an private property ONLY-
ny construction on the public domain (curbs, sidewalks, drlVeW&Ysp
marquees, etc.) will "quire separate permission.
9;D ON KROLL MAP NO.:
I NUMBER ihhLJZ I b
LDDRESS
/ -e/�/ 7 — 17 '4V e- I-C&
YARD SETBACK STREET BET13ACK REAR YARD 8
2,_�� 00, 1
LOT AREA VACANT SITE
E3 YES
HT BUILDING AREA VARIANCE NU
PLA
[3 YES
BUILDING
VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
— _�IGN PERMIT
5 FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
71 FEE
8 1 AMOUNT DUE
ATTENUON
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
0 YES 13 NO
ROUP
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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.
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APPLICATivJN & WORK PERMIT
Application No. .......
CITY OF EDMONDS Building Department Permit Limit, One Yew
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications.
New Residence
''�WONK — New/Addn . ... . ................................................................................. . ........... Ground Area. ................................... No. Stories ........
Vubmitted Rom Holmwall & Associates rrame
........... . ........... . ............................................................. .................. Const. Type .................. o .................... Height .. .........
Ad..Z-�Z.;? .. ... . ..... 10: ................... o ... .................... Use Zone.... S-12 .... Me Zone .... 3
-Wh *--
a lace Tracts, according at thereoi recorded in
So. 80 ft. of Lot 3., W f to pi
0 Pi tgjop!�R� .. ohMi sh
led Lot. / ............... Block ................... Add'n..yq1.t 12..
........ ...... ............ ..... ........... Sewer&ge..A?W.r%! ... . .........
County,, Washington
Box16
7*7 Width. ..... ............ Min. Bldg. Setbacks, Front and Rear.25! ... t ................. Sides ... o7ilt . ......
FWPESO Holnwall 22614 - 91st W
...................................... Addrew.— ....... . .............. Phone ..... q..6.2626
Ron E, Holmwall & Assoce
.. .... . .... . ...... �: ..... . ................................... Address.—jp
ora Ave*Noo
Py .. . .. . ....... . ..... Phone ............... . ...... ........
Seattle
.. ........... . .. . .. .... ............ . ................................................. Address,.—. . ........................ o .... . ...................... . .. . ... Phone .... o ..................... . ...
Addres& ...... . .................. . ........................ .................. Phone. ....................... .......
Reatingby ... ...... . .......... ........... . .......................................... . ... Address. ............... ........................................ ....... Phone ....................... .......
. ............................................. . ...... . .......... . ........... Address. ....................................................... ........... Phone ....................... .......
.. . ..................... . .................................... ............................. ... . ................................ ......................................................................
--
-
-------- - -------- - . ............................ . .. . ....................... .................................... ..... . .. . .. ......... . ................................ . ............................................................
............................................ . .................... .......................... ............... . ..... . ...... . .................. ................. ..... . .......... .
...... . .......... ... . . .... . ... . ................. . .. ........................................................................ . .. . .............. . .......... ... ........... . .............................................. . .. . ..
The above in a correct statement and
efte 0 comp all applicable Codes and State Laws regulating the work.
Le an ....... . ..................
Signed: Owner/Ag .. ............. .. I ...................... ....... Address ... . ....... Same as ab Date ....
...............................
PERMIT for the above work Is hereby approved, subject to the above conditions, and to compliance with the approved plans
and specifications and Building Department notations thereon.
VALUMTON PERam FEES
TJ:J.V.. 6-0
Bldg . .... $ ... . .. ...... . ...................
"PROVED:
-4�
Date ........ .............. . &.3 ............. . ........ 6 3)
BUILDING DEPARTMENT
Plbg. 0 . ......................
Heat... 4 ................ .......................
'5 Elect. $ ... . ...... A .........................
Others ... $ .........................
-7 V
TOTAL FEE $ ....... . ..............
NOTES: No work requiring Building Department or City Engineer's inspection shall be covered before inspection and approval.
Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of an site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
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