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NEW Lj DEMOLISH
ADD I
ALTER RESIDENTIAL
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NUMBER OF
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F� REPAIR I F] NON-RESII
DWELIANG
UNITS
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
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NO
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PERMIT
NUMBER 650046
SET BACK REAR YARD
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
THJIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
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13 YE13 13 NO
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APPLICATION APPROVAL
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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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BURAING PERW
Bulkling Department
IT) I Lt)
Appl. No...../ ............................ .
Permit limit� one year
made for a permit to construct the following work, in accordance with the accom,
w. Two sets are submitted herewith for approval.
Off'St.'
... .... ................. ........................................................................ Parking ......................
..........
.... Const. type ............................... Use zone ..... e 4 ........ Fire zone ...........................
........ Lot ............ ee ...... Blk .......... ....... Addn .. ................................
I ....... I Area ............................................ Septic tank ..........................................................
....................... r. side ............................. 1. side .............................. rear ................................
Addres& .... 60-4-3.3 .... Tel. No ..............................
................... Address ... 0
......... Tel. No ... ......................
........ I ............................ Address .................................................... Tel. No ............................
.. . . ....................................................................... -------
The above is a correct statement, and I agree to
work.
Signed Owner/
with all applicable Codes and State laws regulating this
....................... Date .. C/ a.
PERMIT for the above work is hereby approved, subject to the above conditions, and tDoompliance with the ap,
proved plans and specifications, and Building Department notalions thereon.
Valuation ..... Z-4 ......... ............................... Permit fee ................................ Recd. b .. ...............
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BuildingDepartment, By ............................ ! ................... Date ............ f7 ... ....................................
This Permit does not cover Plumbing, Sewer or Electrical installations.
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