640175.pdfPermit
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ACENSE NUMBER
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Applicant Fin
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DE YARD
Required
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DEMOLISH
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ADD
ALTER
RESIDENTIAL
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REPAIR
NON-RESIDENTIAL
V�fLBER
I UNITS LING
I hereby acknowledge that I have read this application; that the In-
formation given In 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 the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
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PERC.
FIRE ZONE TYE
1 3
SPECIAL INSPECTC
[3 YES ep
BUILDING
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VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
PERMIT FEE
AMOUNT DUE
AT'TENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
zw BACK
REAR YARD
NUMBER
VACANT SITE
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4? A/ &_
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,OT AREA
VARIANCE NUMBER
ALL BUILDING SETBACKS
9k
NOTE: TO EAVE LINES
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PERMIT NUMBEIL STREET GRADE CHECK
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CHEC1*E BY
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VERIFIEEJ�Jp
PERMIT NTZMT;ER
CONSTRUCTION EJTREMT_xMPROVED
13 YES [3 NO
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10. or BLOCS. PZRIBLDG. TOTAL FX9
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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.
DIRMECTOW ONATURE
15ATE
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