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PERMIT 640305
NUMBER
JOB
ADDRESS
01
S 13
IDE YAiRD
SET BACK
REAR YARD
ONE N7BIa
USE
MAP NUMBER VACANT SITE
2.-377/
_ t�
1 //9 'P
0 YES '0,NO
Um
Required
rl YES
NEW DEMOLISH
ADD I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL I UNITS I
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 lawn 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
3IGNATURE (OWNE)R/PR AGENT) DATE 81 NED
"I ZZ2
FILE
[] YES [3 NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
RMArz
[3 YES 13 NO
r&
I
APPLICATION APPROVAL
I
i
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.
. M
D*jr� van DyX, Bldg. 011'1^�al