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a str•r J LAN FILE NUMBER BUILDING
P
ar s� r Building Permit Application
Applicant Fill PERMIT 640236
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Inside Hea Linea r NUMBER i
`'zw{ i. NAME (OR NAME OF BUSINEBB) JOB ADDRESS I '
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NUMBER OF
NEW I DEMOLISH I
ADD
ALTER RESIDENTIAL NUMBER OF
DWELLING
ElREPAIR NON-RESIDENTIAL UNITS
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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 to 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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BUILDING
I VALUATION
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3 PERMIT FEE
HEAT d: GAS LINE
PERMIT FEE
01 AMOUNT DUE
ATTENTION
TIDE PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBfONDB
PR 0-1107
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PERMIT NUMBER
INBTR CTION STREET IMPMrKD
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APPLICATION APPROVAL'
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This application is not a permit until
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signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid,, and
receipt is acknowledged in space provided.
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DIRECTOR'S SIGNATURE
Dirk van Dyk, Bldg. Official
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DATE
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