640439.pdf`5
1jiWing Permit Appl
RCAME OF BIN 85
A
as
ROM.
ENSE NUMBER
I
lc�
Applicant 011
Inside Heavy Lines
(et'
NEW DEMOLISH
0- ADD
ALTER RESIDENTI NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL I UNITS
PROI
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 Workmeres Compensation Insurance.
k1e%.Tr--AMMIT LIMIT ONE YEAR
FW_W5
F�
-SX30,,< 7;
Required
[3 YES [3 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
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER 6404J")
ET BACK REAR YARD
R VACANT SITE
0 YES
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
13 NO
[3 YES 0 NO
TOTAL FEZ I Z
0
I I _r- 4�� 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.
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