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CITY
STATE LICENSE NUMBER
LOT BLOCK
Fill PERMIT
Lines NUMBER.
JOB ADDRESS
IDE YARD SET 13ACK
C77'17 0
7 7 (7- 77 c/ VUILDING
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Required
NEW
DEMOLISH
ADD
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ALTER
RESIDENTIAL
NUM13ER OF
I
REPAIR
NON-RESIDENTIAL
DWELLING
I UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with city and state lawn rcgu-
latID9 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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FILE
NO
650125
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
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[] YES
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
41
PERMIT FEE
DEMOLITION
5
PEnmrr FEE
6 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
01TY OF
EDMONDS
PH 6.1107
13 YES
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspee-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
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RECORD OF INSPECTIONS.
'Date Passed
Foundation
Plumbing (Partial)
(Rough)
I
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Furnace & Fuel
Final
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