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APPLICATION & GILDING` PERMIT �4.� .?�,.....�. • �. No.........
CITY OF EDMONDS Building Department Permit limit, one year
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• APPLCATION is hereby made for a permit to construct the following work, in accordance with the aceom• j
' panying plans and specifications. Two sets are submitted herewith for approval.
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Work addn repair .......... 1 _......... Parking ..........
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Occupancy Const. type .......... ............. :... Use ne. ..` L a ........ Fire zone ,
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Address- ...._. .............��11!`/ 7 �Ik......rIt...•I........ Addr :::, �t ?� ._ I
Lot frontage..• ..................................... Area .......... _.......... .................... Septic tan�L?/ 4�'.:.:-�4��.:......
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Bldg. set�meks —front ........ r. side......... �L..:......:.... 1. side .....�:._•............ rear... ........:
Owne.......................... ddresa...�....................... .........
Builder.................................................................... Address ............................. .....: ......... TeL No............................
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Plans by..,.. ...... •.
Address .....:...............•............ .......
Tel. No......... y
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This permit
Remarks ..........................s{overs...worlf..to...be --d-oru............
on private property 01
Any
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An ..cons ri r��9n..�an...the••publ�c drnttaxYi.... fiIt I
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sicc•rralksts d_iveways, marquees,
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c :.) ;rzll raq.... sr..s para{_e eymf�sloYi..........
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating this ,
work
Signed 6wnerLA ent. - .....- Address. z'^'e ..... Dat��l�?
g .......... ....
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PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the apojj
proved plans and specifications, and Building Department notations thereon. { a
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Valuation �L� 5C�......t✓............. Permit fee..... ?. ..•....... Recd.
Building Department, By ........................... ...
....... Date..,..... ................
This Permit does not cover Plumbing, Sewer or Electrical installations,