650222.pdf0 Applicant Fill
Buildina Permit Application lInside Heavy Ur
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BUILDING
PERMIT
NUMBER 650222
— / I 10 YES [] NO
G A-REA LOT AREA VARIANCE NUMBER—
L BUILDING SETBACKS N
NOTE: AL EAVE LINES 1.
Required
r1i YES I-1 NO
[] YES
[] NO
1V
/4 �. -.#- n
BUILDING
VALUATION
to/
P"
BUILDING PERMIT
2
FEE
DEMO&L
Y�MBER OF ST RI
PLUMBING
,PD
I
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
EYALTER
12 RESIDENTIAL
NUM13ER OF 4
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
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-
ATTENTION
Ized agent of the owner. I agree to comply with city and stato laws regu-
THIS rER5UT
lating construction; and In doing the work authorized thereby, no person
AUTIIOI1UZES
will be employed In violation of the Labor Code of the State of Washington
ONLY TRE
relating to Workmen's Compensation Insurance.
WORK NOTED
NOTE: PERMIT LIMIT ONE YEAR
SlGNATU
INSPECTION
DEPARTMENT
CITY OF
PLOT I,14%< CHROKrPPROVED
EDMONDS
7
PR 6-1107
FILE
[] YES 0 No
1 1 .3, d-,d I
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or lits dw..uty; and fees are paid, and
receipt Is acknowledged in space provided.
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