650259.pdfBuilding Permit Appik tion
NAME (0 OF BUSINESS)
B
MAILING ADDRESS
NAME
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qt? 01 t4
2- 0 1
CITY
NAME
ADDRESS
_15TATE —LICENSE
I I /V- -2- 1 / I MEt Lei
PERMIT
F111 NUMBER 650259
- Lines I I
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SIDE YARD SET BACK EAR YARD
AM A4 A � k� I I m— , /,3�
tr k7 .12 P_S-� ox 11�IUI 1 13 YE13 Er'�O
BUILDING AREA LOT AREA, VARIANCE NUMBER
HEIGHT ALL BUILDING SETBACKS
INE NUMBER rREMAR�KS NOTE: TO EAVE LINES
— 1 4 j j -7-- ( i
NEW Lj DEMOLISH -3
M__ZDD
0---ALTER Q RESIDENTIAL NU LER OF
D=E NG
REPAIR NON-RESIDENTIAL UNITS
I hereby acknowledge that I have read this aPPlICELti0n; that the in-
formation given Is correct: and that I am 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
DATE SIGNED
01 4L -, �,, d
myr PLAN CHECK & APPROVD
FILE
Required
[3 YES
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY Or,
EDMONDS
PR 6-1107
4
[3 YES [:I NO
PEC IZ
1 1.1 5?. J�o I
APPLICATION APPROVAL
This application is not a pernilt 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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