640204.pdfApplicant Fill
Inside Heavv Lines
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TELEPHONE NUMB&
758 Illu
TELEPHONE NUMBE
6 v.2 - .2 -s-'s
-7 -77
LAJ
NEW
LJ
DEMOLISH
ADD
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ALTER
B
RESIDENTIAL
NUMBER OF
F�
REPAIR
F-1
NON-RESIDENTIAL
DWELLING
UNITS
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.
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
APPROVED
0wom
Z.
Required
1`1 YES n NO
It
0 YES
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENT1014
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
PERMIT 640204
NUMBER
— .14zze";
[] YES
ALI BUILDING SETBACKS
NOTM TO EAVE LINES
f (
0
E] YES 13 NO
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I I C//01 a I
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 aelmowledged in space provided.