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POSTED ON KROLL MAP NO.: 13UILDING
PERMIT
.BUIL ING DEPARTMENT Applicant Fill NUMBER 6601524
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME OF BUSINESS) N
SIDE: YARD SEYrBA
/ 9
USE ZONE
MDRE13
or
NEW
1:1
Lj SIGN
ADD
1
DEMOLISH
FENCE
I
ft El
ALTER
RESIDENTIAL
NUMBER OF
jj�k
DWELLING
UNITS
REPAIR
NON-RESII
PR0PnRED-U8E-
I hereby acknowledge Ithat I have read this application; that the In-
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-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of e L;L��ode of the State of Washington
�mpensT
at
relating to Workmen's Cc
or (Except Demolitions which shall
NOTE: PermY0,40t �Ore be completed In ninety days.)
t kqzN S GNED
iIGNA T) A 1
=6TE: Applicant Subject to Plan Check Feer
This Permit covers vrork to be done on private property ONLY.
Any construction on the public domain (curbs, aldewallimp drlve%vnyhp
marquers, etc.) %vIII require meparate permimsion.
0 -LMS 0 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
s
AMOUNT DUE
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
C
[] YES [3 NO 01
VARIANCE NUMB1aU : I
ow
16
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[] YES E] NO
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 acknowledged in space provided.
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APPLICATI(,N
:RMIT
& WORK PE
IT
�,N 1&146�
CITY OF EDMONDS
Building Department
Application NO-*3E
Permit Limit, One Year
Is hereby made for a permit to construct the following work, in accordance with the accompanying Plans .
uls ..... d'.&I.-A ... ::::
.. No. Stories .... /
.... Ground Area ................................. ........
....... Height ........................
Const. Type..
...................... Use Zone=�.r::,/I��Fire Zone ....................
Sewerage ....................................
:Block. ................... Add'n..o
...... . .....................
................... .
Mir- V ....... Sides....
Wldth..�? .. . ......... Min. Bldg, Setbacks, Front and Rear....
"2
..................
ddress .... M-4--Z
Address........................................................................ Phone ................................
.............................................................
Address........................................................................ Phone ................................
. . . ... . .......................................................
......................... Phone ................................
........................................ Address ...............................................
Phone................................
................................ Address ........................................................................
..........................................
..........................................
..........................................
The above is a correct
Address........................................................................ Phone ................................
I agree to cpmPlyjNq�h all applicable Codes and State Laws regulating the work.
... . ... ...
Signed: Owner/Ag:� ress .....
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.
PERMIT FEES
VALUATION
$ ...............
e7, Bldg.
$! -, i
. ............................
Plbg. .... $ ........................................
Heat .... $ ..................
APPROVED:
Date............ ...................................... Elect. $ ........................................
Others... $ ........................................
BUILDING DEPARTMENT
Wm., Herbert,- Bld . Y!ns
TOTAL FEE $ ........ ......
By.............................................................. .... ..........
and approval.
NOTES: No work requiring Building epartment or City Engineer's inspection shall be covered before inspection
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.
I
RECORD OF 1�1.�F,ECTIONS