660227.pdfIOLL MAP NO.: BUILDING
BUILDING DEPARTMENT I PERMIT 660227
Applicant Fill 14UMBER
PERMITAPPLICATION Inside Heavy Lines JOB ADDRESS
I NAME (OR NAME Ulf ISU:SINESS)
G ADDRESS
.0 Al aCCe_
I
—
0
ow
—_
USE ZONE
- SITE
LOT AREA AW17
[3 YES [3 NO
CITY TELEPHONE NUMBER
ff7-4117
HEIGHT
�IJBUILDING AREA VARIANCE NUMUNn
NAME
PLOT PLAN AFFROVNU
ADDRESS
REMAMS
CITY
TELEPHONE NUMBER
REMARKS
METER SIZE SERVICE SIZE -MA1UP"NCE
CITY
TELEYHONIG riu��
REMARKS
STATE LICENSE NUMBER
CITY LICENbal Rium"�"
TYPE CONNECTION VERIPIND ljx
Legal Description of Property (Show Below or Attach Four Copies)
I
PERC. TEST PERMIT NUMBER
I
[] YES 13 NO
[] YES [] NO
BUILDING
WORK TO BE DONE 1 VALUATION Z
BUILDING PERMIT
2 FEE
PLUMBING to
3 PERMIT FEE 4
4
HEAT & GAS LINE
PERMIT FEE
SIGN
NUMBER OF STORIES
SIGN PERMIT
NEW
I
5
FEE
Q
F]"'ADD
DEMOLISH
JE] PENCE
—
DEMOLITION
ALTER
Er RESIDENTIAL
-
NUMBER OF
0
0
6
PERMIT FEE
—
7
PLAN CHECK
ElREPAIR
DWELLING
I UNITS
NON-RESIDENTIAL
FEE
8
AMOUNT DUE
too
I hereby acknowledge that I have read this application; that the In-
ATTENTION
APPLICATION APPROVAL
formation given to correct; and that I am the owner, or the duly author-
ized ag at of the owner. I agree to comply with city and state laws regU-
THIS PERMIT
This application is not a permit until
lating :nstruction; and in doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
tion, or his deputy; and fees are paid, and
relating to Workman's Compensation Insurance.
WORK NOTED
receipt is acknowledged in space provided.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
DATE SIGNED
INSPECTION
DIRECTOR'S BIG
DEPARTMENT
CITY OF
EDMONDS
NOTZ Applicant Subject to Plan Check Fee
PR 6.1107
s Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FILE
nvarquees, ctc.) will require. separate permission.
BUILD
P CATION ING PERMIT
OF EDMONDS Permit limit, one year
Building Department
ing work, in accordance vith the accom,
PLICATION is hereby made for a permit to construct the follow
11�1�� pany I ing plans and specifications. Two sets are submitted herewith for approval.
Off -St.
alter
new
Work addn repair ... ...... ................... ........ Parking . ...........
...... Const. type . .......... .................. Use zone ... 1Z!n--t9 ........ Fire zone ..... ............ . ...
Occupancy ......
c:;:2 / 70 7'
Add ress ....... 01 Lot ........ .. Y.:� ...... Blk .............. o ......... Addn... .......
............... 14c)
............... Septic tank ........ ........................
Lot frontage .... ................... 20 ..... Area ...........................
...... 0... 1. side .............................. rear ..... ...............
Bldg. setbacks front ............ r. side ..........
1. No .... 4L
... ......... ....
Owner......Aae
..... .......... Address. .... ....................... Te
Address........... ........ ................... 0 ........... Tel. No ... .........................
Builder... ..................... ------------------ - ---- ..................
Plansby ................................................ 0 ................ Address... ........... o ............................... Tel. No .............................
Remarks......................................... 0.0 .......... 0 ........... 0 ... . ............................. 0 ... 0 ..................... 0 ...................... 0 .... 0 .....................
The above is a correct statement, 'and I
work. I I
Signed Owner/
to comply with all applicable Codes and State laws regulating this
Address............................................ 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 Department notations thereon. /�7/ Z�
Valuation ........... ...................... Permit fee ..... :;�A:t ............. Recd. by ....... t--z ................... ..............
...............................
Building Department, By ................. . ................... Date..
..... A ............... _-1-7- ..
INSPECTION RECORD
Fdn, OK ......................... I ................... Frame, OK ............................................... I ..... Final, OY, .......................................
This Permit does not cover Plumbing, Sewer or Electrical installations.