650248.pdf_____._.____.__._ .. .- � I — � __ - .- - - � I _ � . . - . I - . _ __ - - .- - .- - - � - I I - I- - -
I App Icant Fill
mg Permit Application Inside Ileavy Lines
(OR NAME OF BUSINESS)
A/ Z)
TELEPHONE NUMBEat
t, �_ -
f4 V6. V
—a I Q
PERMIT
NUMBER
DRESS
fo
ARD
SET
BACK
x
;ONE
MAP
ci— — / 7—
Required
BLOCK TRACT
0* )7 t"C
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le mil -de 1
0 &L�l 'ne- ewe'746 1q ele ;�L 0 >w, TYPE
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PLAN
en .26
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WORK TO 1319 DONN
Rs:
ft — - � _.. - _. - .0 f- " �. `0 J-,, A �. L-� BUILDING
NEW DEMOLISH
ADD :2-
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-RESIDENTIAL UNITS
I hereby acknowledge that I have read this application: that the in-
formation given is correct: and that I sm, the owner, or the duly author-
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.
NOTE: PERMIT LIMIT ONE YEAR
31ONATURE (uWN191t UK Au��A; DATE IGNED
T_� PLAN CHECK & APPROVED
FILE
NO
0
SIM
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
ITEAT & GAS LINE
4
PER261IT FEE
DEMOLITION
PERMIT FEE
a
AMOUNT DUE
ATTENTION
THIS PER551T
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
��50248
REAR YARD
4
VXACANT SITE
[3
1?3YES CE NO
11
VARIAN JE NUMBER
ALL BUILDMU bNK�Ku�c
NOTE: TO EAVE LINES
,-Cc.
V
STREET IMPROV]
[j YES [:] 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 acknowledged In space provided.
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