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HEAT & GAS LINE
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NUMBER OF
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DEMOLITION
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NON-R
UNITS
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
lzed agent of the owner. I agree to comply with city and state lawn regu- THIS PERMIT
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE
relating to Workmen's Compensation.Insurance. WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR I
IIGNATUR��OV INSPECTION
PER R AGENT) DATE: SIGNED
DEPARTMENT
OITY OF
�07` PLAN CHECK & APPROVED EDMONDS
PR 6-1107
FILE
I
iii5wi�'- 650180
NUMBER
El YES [3 NO
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
[I YES 13 No
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 aclmowledged in space provided.
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