660293.pdfI
0
----- ---- --
..... . ........ I ...... ...
LL MAP NO.:
BUILDING
PERMIT -)60293
6
BUILDING DEPARTMENT
Applicant Fill
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JO ADDREBS
,
x"/ a d — /�
// .
NA
SIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
G ADDRESS
USE ZONE LOT AREA
VACANT SITE
ONE NUMBli!R
C] YES [3 NO 0
6
9, G _HT BUILDING
AREA VARIANCE NUMBER
I
NAME
APPROVED
ADDRESS
REMARKS
CITY
or
[] YES
TYPE OF
W&U,
YES Ej NO
m
BUILDING
N I N
VALUATION
TO BE DONE 1
WORK
BUI ING PERMIT
FEE
2
3IN
PLUMBING
3
PERMIT FEE
7
0
HEAT & GAS LIND
4
PERMIT FEE
I
SIGN PERMIT
NEW
SIGN
NUMBER OF STOIRUIES
5
FEE
DEMOLITION
ADD
DEME03LISH.
FEN CE
—
ALTER
11 RESIDENTIAL
NUMBER OF
6
—
INA
PERMIT FEE
REPAIR
NON-RESIDENTIAL
DWELLJNG
UNITS
7
PLAN CHEW,
FEE
81
AMOUNT DUE
7�
I hereby acknowledge that I have read this application; that the in-
ATTENTION
APPLICATION APPROVAL
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 state laws regu-
THIS PER311T
This application is not a permit until
lating construction; 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; find fees are paid, and
relating to Workmen's Compensation Insurance.
Wolut NOTED
receipt is acknowledged In space provided.
(Except Demolitions which shall
NOTE: Permit rimit One Year be completed In ninety days.)
---------
DIRECYO 8 SIGNATURP
,;o
f
SIGNATURE (OWNER OR AGErjT) —D-Ai�TE SIGNED INSPECTION
DEPARTMENT
Af
CITY OF
ATE
EDMONDS
L
NOTE: Applicant Subiccl to Plan CheckFec
Pit 0-1107
Title Permit "'ven %vork to be done on private property ONLY.
Any Construction on tile public domain (curbs. sidewalks, driveways,
FILE
marqueesq etc,) will require separate permission,
I
j
U
I
APPLICATI & WORK PERMIT
Application No. .7
CITY OF EDMONDS Building Department Permit Limit, One Year
APPLICATION is hereby made for a permit to construct the following work, in accordance with the accompanying plans
and specifications:
WORK— New/Addn . ...... . ..... L/4;.a. ......................................................... Ground Area. ................................... No. Stories ............
Plans Submitted ...........
Height .......................
...................
e..%. 72�. Fire Zone ....................
LOCATION — Address ................. e�a .. a.1 ............................. = .. .5
v ... ......... ............. 'Use Zon
...... (� ............... Sewerage .. ........... .....................
Recorded Lot ........ / ........ Block . .................... Add'n....
Lot Area_./��i..'L_V_v Width ... cfO ...... 2�1. Min. Bldg. Setbacks, Front and Rear;;� ......................... Sides ..... ZA . ....
...........................
Owner .. ....................... Address .............
.........
...................... P�qne ...
.................... ........ /-/L, 6 -7 ;7,0
...... ... ..................... Address ........................................................................ Phone ................................
Plans b . ........ .....
Bldg. by ......... ................................ Address ........................................................................ Phone ......................... .......
9�� ............................ Phone ................................
Plbg. by ........................................................................................... Address ............................................
Heatingby ........................................................................................ Address ........................................................................ Phone ................................
Elect. by
Remarks
The above Is a correct
Signed:
Address........................................................................ Phone ................................
and I ee Jo comply with all applicable Codes and State Laws regulating the work.
........................................................ : ................... 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.
VALUATION PERAM FEES
..........
$ Bldg. $ ... . .....
. ...........................
APPROVED:
Date .............
4 ..............
BUILDING DEPARTMENT
Wm., Herbertc Bldg. Insp.,0J4+
By....................................................................................
Plbg. $ .... ..... . ................
Heat.... $ ......... ..........................
Elect.
Others... $ ........................................
_.--e
TOTAL FEE
... / ... ... . . .................
NO
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 all site utilities, such as
curbs, paving, driveways, sewer, water and street connections.
tj