650276.pdfAPPIKUTIU11 I InsW Heavy Line
USINESS)
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E"PH—ONS NUMBLft
, I
7- �7 4
TELEPH)NE NUMBER
OW 17
.=5-0 -_�
eARD
Required
0 YES
METER
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NEW
Lj
DEMOLISH
M000�11
ADD
FjALTER
RESIDENTIAL
og
NUMBER OF
I
F�
REPAIR I
n NON-RESIDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly allthor-
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 LIMjT_ONE YEAR
I;UG ATl��
Sl_ �N OR 0 AGENTI
�10
URE DA;TE71GN D
PLOT PIA1% CUE&/& APPROVED
VI LE
I
[] YES
Me
I
RM
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
TIUS PERBUT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 6-1107
PERMIT
NUMBER
ACK
650276
AR YARD,
7-J
LAP NUMBER VACANT 8
YES NO 0
!I
,OT AREA VA INCE Nv��ER
ALL BUILDING SETB CKS 04
NOTE: TO EAVE LINES
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N
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STREET IMPROV!
[] YES E3 No
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APPLICATION APPROVAL
This application is not a pern-At until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged in space provided.
12
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