660249.pdfBUILDING DEPARTMENT Applicant FLU
PERMIT APPLICATION Inside Heavy Lines
I MIME
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FIRE ZONE TYPE 0;
SPECIAL INSPECTOR-R—E
YES NO
d
0
PLAN CHECKED BY
WO TO BE DONE q
1
BUILDING
VALUATION
06
BUILDING PERMIT
/670
2
FEE
PLUM13ING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
NEW
SIGN
NUMBER OF STORIES
SIGN PERMIT
ADD
DEQ
MA
n
kfj�
FENCE
5
FEE
—
6
—
DEMOLITION
PERMIT FEE
4
F-1 ALTER
Pq RESIDENTIAL
Uj—
NUMBER OF
11 REPAIR
1
11 NON-RESIDENTIAL
DWELLING
UNITS
1
71
PLAN CHECK
FE
FE
PROPUBED UBE
8
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author-
ATTENTION
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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
IExcopl Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
r
3
DEPARTMENT
CITY OF
EDMONDS
NOTE: Appficant Subject to Plan Check Fee
I -It 6-1107
Thin Permit coven work to be done on Private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc., will require separate permission.
9
� Zal �5_r/qe/,19 //6A
ro.: BUILDING
PERMIT
I NUMBER 660249
0 YES
[3 NO
UMBER
[:) YES [3 NO
1 1 C-7, &%-Zi I
APPLICATION APPROVAL
This application is no ' t a permit until
signed by the Director of Building Inspec-
tion, or his deputy; find fees are paid, and
receipt is acknowledged In space provided.
FILE
" r,
Appl. No. . . ....
APPLIOATION WILDING PERMIT
ear
permit limit, one y
CITY OF EDMONDS Building Department
in accordance with the accom,
APPUCATION is hereby made for a permit to construct the following work,
panying plans and specifications. Two sets are submitted herewith for approval.
Off -St.
new &,,� alter
Work addn repair ...... tz ............................................... Parking ......... . .
Occupancy ................................ Const. type ................................ Use zone ......... ...... Fire zone ...........................
45 Addn..4*900-� ..... 7"
�ot ................... 7 .. Blk ........................
Address .. ...... ..... �IAA)t W
0 P;W — I P/ ooqu.167 6c.).
Lot frontage ....................................... Area ........................................... Septic: tank..' V/ r. ...........
10 ' rz:ffl�
Bldg. set -backs — front ............................ r. side ............................. 1. side ............................. rear ................................
-R ......... Address..-;Z.: -4-7�z ........... Tel. No .............................
Owner ... ...............
41 ............. Address. .................................................... �Tel. No.. ...........................
�Builder ............................................... .......
�J
Address.................................................... Tel. No .............................
Plansby ..................................................... . .. .. ....
Remarks.............................................................................................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
T Date-J/62
Signed Owner/Agent: ...... dress .........
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. by ... ........ .
valuation ........... .............. Permit fee...' _z 4 ------- 7 ..........
....................... Date . .................
Building Department, By .......................
Fdn,. OK ...............
INSPECTION RECORD
Frame, OK
Final, OK .................................. . ...
This Permit'does not cover Plumbing, Sewer or Electrical installations.
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