640308.pdfA)
Applicant Fill
Inside HeavY Lines
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SIDE YAr
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TE-LEPRONE NUMXI�n
UFON, I,
B
PIT WW6 6,
UILDING
3�2 /1/
a
NEW j-1 DEMOLISH
ADD I
ALTER kcn NUMBER OF
RESIDENTIAL DWELLING
REPAIR NON-RESIDENTIAL I UNITS
C,O,A "2::=� —
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
FIG —NATURE —(OWNER OR AGENT) DATE SIGNED
FILE
Required
r'l YES 0 NO
0 YES [] NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
JVORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
PERMIT
NUMBER
7P j "
BET BACK/
MAP NUMBER
/0 --7
ALL BUILDING �
NOTE: TO EAVE LINES
T SITE
[3 NO 0
WE NUMBER
[3 YES [] NO
L. FEE Z
r to
4
I � I C�-, &T--j I
APPLICATION PPROVAL
This application Is ,lot 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.
IN