640457.pdf... ... .....
Applicant Fill
Building Permit Application I Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
*ktaRe �DREZ 'S:7 49 Y'V
c4
-7
.3 /B 7 0 /,).o 408� We3_ 7
CITY
LEPHONE NUM13ER
'74.3
190-09 /W 0 OOU
— 2,9 1,6
NAME
014iwo� 'o-012'ejex -
ADDRESS
17-706 ZZA;f
-
CITY
xh;"PHONE NUMBER
dt O/VZ25
4029
NAME
.,0�0 y/.) j:�W. AV A0 0.e s 40
-ADDRESS
CITY
TELEFRUNE 14 UMBER
17-
C-9:21 I I
-5.400AJ,0 V/A=_k_-7
S,=-Z p 7- . 2 7 X
WORK TO BE DONE
Laf NEW DEMOLISH
ADD I Z_
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR I HO�NON-R UNITS
I hereby acknowledge that I have read this application; that the in-
formation given to 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 vlolation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
im—N-A-TYRE (OWNER OR AGENT) DATE SIGNED
PLOT
44ADI
;7;?�
P
Required
11 YES
0 YES
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS IaNE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
640457
NUMBER
I
[] YES 13 NO 0
,OT AREA VARIANCE NUMBER
ALL BUILDING SETBACKS N
NOTE: TO EAVE LINES
cd, OLE,-
91 �i
1 14,�s o NO
'UPANCY GROUP
PERIBLOG. TOTAL Pitt Z
ow W
1D 0
-7 #`V
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.