650109.pdfPERMIT
Iding Permit Application J,n A d"of III 'canv'y Tin e SON Lj E I NVMBER 650109
ME (OR NAME OF BUSINESS) JOB ADDRESS
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ILINO ADDRESS SIDE YA�D SET BACK REAR YARD
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I TEUVPHONE NUMBEA US)p MAP NUMBER VACANT SITE
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ALTER
Er RESIDENTIAL
NUMBER OF
I
F�
REPAIR
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33WELLING
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 allthOr-
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
relaUng to Workmen's Compensation Insurance.
NOTE: PERMIT LIMIX=Q-NE YEAR
0 �/ I "-,A �r
FILE
Required
rl YES
YES
I I VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & -Ehfr�
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
0 1 AMOUNT DUE
ATTENTION
Tins PEIL311T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
ALL BUILDING BET33ACKS
NOTE: TO EXVE LINES
I e
or
VFW
[] YES 13 go
MA
00
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 aelmowledged In spade provided.
DIRECTOR'S SIGN.4.TXjRE
DATE��---
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