660548.pdfBUILDING DEPARTMENI
PERMIT APPLICATION
NAME (Oft NAME OF BUSINESS)
G ADDRESS
:T T 414
momp-5 60
........ . ..
POSTE6
r Applicant Fill
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ELOLL MAP NO.: BUILDING
PERMIT
NUMBER 4,tnr-) A R
/ If I "
YES 0 0
R
VARIANCE NUMBE
KAu s �F
REMARKS
14
-ADDREBB
A k C.� 3 79 Z U)
METER SIZE SERVICE SIZE CLEARANCE CHECKEI) BY
CITY
LEPHONE NUMBER
TFPR
60 Al
6
REMARKS
_S
STATE LICENSE NUMBER
CITY Liclarium NUMBER
TYPE CONNECTION VERIFIED BY
Legal Descrip7jon 'ofFroperty (Show Below or Attach Four Copies)
AA1,0 Z5 C. 1C.
PERO. TEST PERMIT NUMBER
Pi.. A T-
[] YES MAN15-
EVr!r8_ 13 NO
BUILDING
WORK TO BE DONE
R913LJ 14- A 01VIE JA)e7'
VALUATION
-7, IrO
BUILDING PERMIT
FEE
Z
3
PLUMBING
PERMIT FEE
UD
HEAT & GAS LINE
4
5
PERMIT FEE
SIGN PERMIT
FEE
NEW
ADD
JE3
DEMOLISHI
SIGN
[:] FENCE
NUMBER OF STORIES
6
DEMOLITION
PERMIT FEE
0
MREPAIR
ALTER
R� -
N RESIDENTIAL
I El NON-RESIDENTIAL
-_
13ER OF
NDUWMEBLLING
UNITS
—
7
PLAN CHECK
FEE
PROPOSED USE
8
AMOUNT DUE
0
I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
ATTENTION
APPLICATION APPROVAL
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 Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
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.
DIREgr0jrJ3 AIGNA
4�' f
DATE
FILE
This Permit covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require separate permission.
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-7777-777�-
APPLICATION BUILDING PERMIT Appl. No . .... .......................
Permit limitL one year
CITY"OF EDMONDS Building Department
owing work,.in accordance with the accom,
CATION ishereby made for a Permit to construct the foll
. 9-P and specifications. Two sets are submitted herewith for aPPr0vaL
Off -St
Aew alter
................. Parking ............. .....
d 'air .................................
rep..........................
......................
CT ............................... Const. type ............................... Use zone ..... k ............. Fire zone.......
......... .................................
Lot ........................ Blk ....................... Addn..
....... Area ........................................... Septic tank ..................................................... ...
........... ..................
front........................... r. side ............................. 1. side .............................. rear ................................
No............................... .
................. Addres&�&OfJt ...... . .............. ...
... .....................
Address..;*L-4 ... ECA�-Ar . ............... .... Tel. NI�Z5r�.Ize
ilde'
Bu, . .. ..... ...
.. 11 !L--'1. .. -
-� .............
......................... Tel. No .............
................
Plansby .............................. I.., ................................. Address ................. .. .......
Remarks............................................................................................................................ ................................................. ....
..................................................................................
................................................ ....... ...... ...........
................ .. ......... ....... ...................................... ......... ...........................
. ....................................... — .....................
Th�4bov I e is a correct sLtatmentl d I agree to comply with all applicable Codes and State laws regulating this
work..
e4
Address..................................... Dat ................ .
Signed Owner/Agent.
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the ap,
provr;d plans and specifications, and Building Department notations thereon.
e%Ae
................ - Recd.
Valuation ... 010J2.0 .......... ffi .................... ... Permit fee ...........
Building Department, By ........... 0 ............. ............. 0 ............... Date ....... .......... ................. ....
This Permit doesnot cover Plumbing, Sewer or Electrical in=114tions-
I
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