660220.pdfPOSTED ON KROLL MAP NO.: 13UILDING
PARTMENT Applicant Fill PERMIT
BUFLI)ING DE NUMBER 660220
PERMIT APPLICATION Inside Heavy Lines I JOB ADDRESS e,
NA2!E OF BU ESSY 2.
SIDE YARD SE7rDXCK I STREET SETBACK IREAR YARD 8
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NEW
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ADD
DEMOLISH
"SIGN E
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09
ALTER
RESIDENTIAL
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IT'
NUMB
F�
REPAIR
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NON-RESIDENTIAL
DWELLING
UNITS
I "'Y led go that I have read this application; that the in-
foro2Rtjc�rglv,j2=, Crre,t; and that I am the owner, or the duly author-
ized agent,of / thpAwner. I agree to comply with city and state laws regu-
lating co n; ?Ing th k authorized thereby, no person
will be XP.11A ed In elation lzrrcHode of the State of Washington
Cc atil
rela 9 or an's Col tion Insurance.
IE ... pt Demolitions which Bhal)
be completed in nineV dayso
WTE: P! it Ljoeit One Year
NOTE: Applicant Subject to Plan 6jeck Fcle
This permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate perminslon.
Cj YES
E] NO
UMBER
M REMARKS
METER SIZE I SERVICE SIZE
CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED 13Y
PERC. TEST
PERMIT NUMBER
[] YES [] NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERM T
5
1, EE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[] YES [] NO
1 1 _52- &�-� �, I
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 aclmowledged in space provided.
FILE
---- ------
BUILDING PERMIT Appl. No. Z .......
ITY.;'OF EDMONDS Building Department Permit limit, one year
I- r-11 --,— —�A- *� ��r^rAnnce with the accom-
kPPLICATION is hereby made for a permit to nstruct e o r,
g plans and specifications. Two sets are submitted herewith for approval.
new alter Off -St
Workaddn repair ....................... .......................................................... Parking ......................
Occupancy ...... ......... Const. Vpe ................................. Use zone ......... C ........ Fire zone ...........................
..............
Address ...... IM ........ . ...... Lot ......................... Blk ........................ Addn ......................................
.................. Area ........................................... Septic tank ..........................................................
Lot frontage ......................
front ........................... r, side ............................. 1. side ..... ... ................... rear .......... .....................
Bldg. setobacks
��9-Tel. No ..... X�.ZK&
OwnerBM!� ............ Address .... . . ..........
.................... Address ............................. ...................... Tel. No .............................
Builder ...............................................
Plansby .................................................................. Address ........................................... ........ Tel. No .............................
........................................................................................................ ................... ..........
Remarks
..................... ........................................................ ................. ............................................. ..................................................
............................. ...... ........................................................................ .......................
..............................................
regulating this
a ee
The above is a correct stateq&t, and I to c ply with all applicable Codes and State laws
work. —IV`,
Signed
........................................... Date..
.. . ..........
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 Departa�e�pnotations thereon. '. )
ecd. by.�—Xa7 .....
Valuation ............ /A�--� ............................ Permit fee ......... ............... It
C *, . 7
Building Department, By .......... Z�/- W ............................................... Date ......... ....................
This Permit does not cover Plumbing, Sewer or Electrical installations.
'APPLICATION BUILDING PERMIT
wITY OF, EDMONDS Building Department
Appl.
Permit limit, one year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom,
g plans and specifications. Two sets are submitted herewith for approval.
new alter Off -St.
addnrepair ........ ..................................................... Parking ......................
e ...... R.—I ........ Fire zone ............................
Occupancy Const. PC— ........ ................ Use zon ....
6-0-
Address.
.. .. . ........ Lot ....... . I .. .... Blk ....................... Addn --"4
Lotfrontage ........................................ Area ............................................ Septic tank .................................... ................
ZZ..r ........ r. side ............................. 1. side .......... AQ ........... rear ................................
Bldg. set -backs front .......
Owner .....
.42 Address,..7 ... ...................... 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/Agento, e7c 4 .... Address ............................................ Datel.�n�.:::..4
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 therecon.
Valuation ...... ..................... Permit fee ..... 3.`7 ................. Recd. by ........... r( ........ �,
Date ........................ . .......
Building Department, By... .................... o ................. .................
This Permit does not cover Plumbing, Sewer or Electrical installations.
A