650365.pdfDEPARTMENT I Applicant Fill
APPLICATION 'nedeReavy unes
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ADD
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FENCE
ALTER
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RESIDENTIAL
NUM33EK UL,
REPAIR n
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NON-RESIDENTIAL
DWELLING
UNITS
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-
ized agent of the owner. I agree to comply with city and state laws rOgu-
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 Workman's Compensation Insurance.
(Exc-Pt Demolitions which shall
E: Per it Limit One Ye be completed In ninety days.)
I A, URE R OR AGENT) DATE SIGNED
NOTE: Appli"nt Subject to Plan Check Fee
This permit coven work to be done an private property ONLY.
Any construction on the public domain (curbes sidewalkst driveways,
manuees, etc.) will require separate permission.
I
,P NO.:
BUILD
PERMIT
650365
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NUMBER
B
/BE
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LOT AREA
VACANT errs
13 YE13 [3 NO
-REMARKS 6
Z
11 SERVICE �RI=7_6_LEARANCE
M7 SIZE I CLEARANCE C BY
5 a It I I
REMA. 8
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YES M40
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
FLUM13ING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
Title PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PE 6-1107
13 YES 0 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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RECORD OF INSPECTIONS
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Furnace & Fuel Lines
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