640352.pdfI- . - 1. .1 .- -1--_ _.- I ... I—. - .. - . - . -.1.1- . - .. I .. I I-- - I - I . .__ ------ ----
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Applicant Fill PERMIT
it Application I Inside Heavy Lines NUMBER 640352
'.BUSINESB) JOB ADDRESS
�J'�AJ 1-77 f? ') / , — r) I I
74
UNT ISAU
REAR YA
'�D
TELEPHONE 14 UMBER
0
PONE
MAP NUMBER
VACANT SITE
YES M�No
d vc
BUILDING AREA
LOT AREA
vi
HEIGHT
NOTE:
ALL 13UILDING SETBACKS
TO EAVE LINES
r A
WORK TO BE DOt5/
Op c)("S%
NEW DEMOLISH
ADD /11� I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL I UNITS
PROP90yjW USE
I I- -C� /),I �?10 0 /*1 A
I hereby acknowledge that I have read this epplicationuhat 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
rwiti
Required
11 YES rl NO
[3 YES [] NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE:
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERBUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECT10N
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
OF
R//- "/,(
;11
0 YES [3 NO
.EK—F Z
I I t-.f " 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 acknowledged in space provided.