650197.pdfi Permit Application IRS a gam:
R NAME OF BUBINEBS).
JDDRE88
1TELEPHONE NUM
744 - 3c ] 1
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BUILDING
VALUATION
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BUILDING PERMIT
NEW
ADD
DEMOLI8H
I NUMBERFEE
PLUMBING
PERMIT FEE
HEAT k GAB LINE
PERMIT FEE
ALTER
REPAIR
I RESIDENTIAL
NON-RESIDENTIAL
L DWELIN
I NUMBER tLIS
UNITS
DEMOLITION
PERMIT FEE
9ED UBE
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
Ized agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT
lating construction; and in doing the work authorized thereby, no person AUTHORIZES
will be employed lu 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
BION
ZTURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
t Qr` CITY OF
PLOT PLAN CHECK ! APPROVED V EDMONDS
PR 8-1107
I
650197
YES ❑ NO
NOTESALL BUILDING
TO EAVE LINES SETBACKS
Aug
r
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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