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Telephone Company
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ATTENTION: PERMIT APPROVAL I
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THIS PERMIT THIS PERMIT DOES NOT BECOME (p
AUTHORIZES VALID UNTIL SIGNED BY THE Z
BUILDING OFFICIAL OR HIS DEPU- ! O
ONLY THE
TY, THE FEES ARE PAID, AND RE- i
I hereby acknowledge that I have read this application; that
RELOCATION CEIPT IS ACKNOWLEDGED IN THE i O
the information given is correct; and that I am the owner, a
OF THE SPACE PROVIDED M
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duly licensed moving contractor, or the authorized agent of one
of these. I agree to comply with city and state laws regulating
BUILDING
NOTED
building relocation; and in doing this work, no person will be
employed 1n violation of the Labor Code, State Of Washington
By , ,,, , Ll,_'.. !.. ...... ...... ....................
relating to Workmen's Compensation Insurance,, S b/ �,
Signature of Owner, �����r,
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AuthorizedAgent .......... ...... ................ .......` _._...._..._.�7......
DEPARTMENT ..../......................»
Date
Phone ,�%' J'
Signer's j1 U%,...�Address No.
CITY OF 1
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EDMONDS
DISTRIBUTION OF COPIES
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City State .................................
e7%�.-` WHITE —File (Bldg. Dept)
...............................................................
YELLOW —Move Inspector
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C.�L.GL GREEN —Assessor
Police Dept.
Date ..-..... .........................._...................................
GOLDENROD —
PINK — Moving Contractor