660271.pdfBUILDING DEPARTMENT Applicant FLU
PERMIT APPLICATION Inside Heavy Lines
MrjEj�NGDFXSB
D ON KROLL MAP NO.: BUILDING
PERMIT
NUMBER 66027 1
ST 5.
41
YARD sE;Troj:c—fc I'STik-EErr SETBACK REAR'YARD llkrrk$Ak�
4
6 - "2
Lo-r 'A LAit%A, 061245!�.
ZONE TYP E 0
—INSPECTOR
SPECUCK R
M
YES NO
PLAN CHECKED BY
WORK TO BE DONE
BUILDING
I VALUATION
BUILDING PERMIT
4 FEE
PLUMBING
Z
3 PERMIT FEE
0
HEAT & GAS LINE
4 PERMIT FEE
NEW SIGN NUMBER OF STOIRUIES
R
SIGN PERMIT
5
SH E
ADD DEMOLI rENC
FEE
—
DEMOLITION
ALTER RESIDENTIAL NU BER OF,
PERMIT FEE
FLIJNG
I UNITS
PLAN CHECK
7
REPAIR NON-RESIDENTIAL
FEE
8
AMOUNT DUE4
I hereby acknowledge that I have read thin application; that the In-
ATTENTION
formation given Is correct: and that I am the owner, or the duly author-
ized asent of the owner. I agree to comply with city and state laws regu-
THIS PERMIT
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
ONLY THE
relaun erVa Compensation Insurance.
WORK NOTED
(Except Demolitions which shall
NOT rmit Limit ne Year be completed In ninety days.)
SIGN (0 E w� SIGNED
INSPECTION
DEPARTMENT
CITY OF
MMONDS
NOTE: Applicant Sitbject to Plan Check Fee
Pit 6-1107
This rcrndt covers work to be done on private property ONLY.
Any construction m the public domain (curbs. sidewalks, driveways.
marquees, etc.) will require separate pertnisnion.
[] YES
13 NO
'UMBER
[] YES 13 NO
'cg 00. o a
311',:� 1 ,-2. eq 0 1.
APPLICATION APPROVAL
This application Is not a permit until
signed by the Director of ]3uliding Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
DIAEPT 8 blu Itz
FILE
f
Pi�n�WIJCATIOA%4 BUILDING PERMIT
AP
OF EDMONDS Building Depan M ent
MITY
lwl-'.
Appl. No.
Permit limit, one year
ATION is hereby made for a permit to construct the following work, in accordance with the accDm,
plans and specifications I 7T sets are submitted herewith for approval.
new alter Off'st.
......... Parking ......................
addn repair ..... 1� .... .. .. ....................................................................... ... 7
pancy ................................ Const. type ................................ Use zone ... :.3 ....... ....... .. �.�Fire zone ...........................
.!.Address ... z) .. ......... v ........... FV Lot ......... 41 .... ... BIV.A .... A .............................
......................................... Septic
t�t frontage ........................................ Area...
Bldg. wt+acks front ..... ............... r. side ....... ......... 1. side ........ .. .......... rear .. ............
Owner..,&V. ... ..................... Address..2///..2dC(—.- C .. ..... k// Tel. N?
Builder.............................. ................................ Address .................... ......... .................. Tel. No ..............................
Plansby .................................................................. Address .................................................... Tel. No .............................
Remarks...... eI V6 ..... ............. 1,91 . . ..................................................................................................
.................
......... . . . ............................................................................................
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this
work.
Signed Owner/Agent... f��q
� .. 4 ......................... Address�.e/ ............ Date!f
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.
Ilual ....... /1/,' OJD.0.-� ............... Permit fee.,-�k ... 7 ............ Reed. by..�..
Building Department, Date .... ..................................
This prrr.1'11; covers wor1c Wbe dd'ne-
NOTE —0TUR"er'01i't spwe-r or electrical installations, nor does it permit any work to be
done in I YS 'a
1�f 1* -wz d 611'tAgCto W must be planned to meet the official grades of stree
and alleYsJ&'A&Tl4ns Vf1f44Q
9tc.) will require permission.
9
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