640388.pdfApplicant Fill
Building Permit Applicationj Inside Ileavy Lines
NAME (OR NAME OF BUSINESS)
H. VV 1/0 1) IS C1
MAILING ADDRESS
Ci
CITY TELEPHONE 14UhII5ZkL
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NAME
ID .,/\I Y-1 C.—
ADDRESS
TMERR
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Required
r-1 YES n NO
_1.-, 9 h - 3�2_ 0 A- r-j j
5_2 lit
9.j
e 0-C %_jard
ElNEW
DEMOLISH
NUMLMn Uk' bTO ES
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El ADD
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ALTER
RESIDENTIAT
NUMBER OF
REPAIR
NON
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
3IGNATURE- (OWNER OR AGENT) - DA ED
2. 2
PPROVED
FILE
[3 YES 0 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS IINF,
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTE ION
TRUS PERMIT
AUTHORIZES
ONLY THE
JVORH NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1207
PERMIT
NUMBER 640388
7yr/c�-__v ;z_ 7'e�l
1 [3 YES (3 NO
,OT AREA I —VARIANCE NUMBER
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
10 YES [] NO
'AL. FEE I Z
01
I I I'/- e_7rd
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 acimowledged in space provided.
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