650130.pdfBuilding Pi
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BUILDING
PERMIT 650130
NUMBER
,ET BACK REAR YARD
LAP NUMBER VACANT SITE
3 NO
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,OT AREA VARIANCE NUFM13ER
ALL BUILDING SETBACKS ow
NOTE: TO EAVn LINES
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NO. OF BL668.
PER[16LAG.
__jOTAL PRE
g
VALUATION
2
BUILDING PERMIT
FEE
NUMBER OF STORIES
3
PLUMBING
PERMIT FEE
NEW
ADD
El DEMOLISH
Zalo
El
4
HEAT & GAS LINE
PERMIT FEE
ALTER
M71
RESIDENTIAL
NUMBER OF
REPAIR
I NON-RESIDENTIAL
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
PROPOSED USE
6
AMOUNT DUE
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-
ATTENTION
APPLICATION APPROVAL
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.
THIS PERMIT
AUTHOR[ZES
ONLY TILE
WORK NOTED
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is acknowledged in space provided.
INSPECTION
DEPART261ENT
SIGNATURE (0-1-vNER 01' AGENT)
DATE SIGN D
DIRECTOR'S SIGNAT t
CITY OF
EDMONDS
ru a .1107
DATE�/
P P R APPROVED
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