650459.pdfI
BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Lines
NA (OR NAME OF BUSINESS)
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MAILING ADDRESS
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CITY TELEPHONE NUMBER
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NAME
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1 CITY TELEPHONE NUMBER
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CITY TELEPHONE NUMBER
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NEW SIGN NUMBER OF STORIEk
ADD I DEMOLISH FENCE
Q- ALTER B_ RESIDENTIAL
V�ZER OF
REPAIR NON-RESIDENTIAL I UNITS LING
PROPOSED USE
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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 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.
IE,C,ll Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
BIG TURE (OWNER Opf-jqGENT) DA E S. 'GNED
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NOTE: Applicant Subjcct to Plan Cbeck Fcc
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ma"u0cs, etc.) will require separate per"Asion.
I
'V 75 -
LRD SETBACK
[] YES a -fro
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
SIGN PER16UT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
71
FEE
8 1 AMOUNT DUE
ATTENTION
THIS PERMXT
AUTHORIZES
ONLY TIEE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
PERMIT
NUMBER
3ETBACK
650459
0 YES
d
Z
f4
i
[] YES 13 NO
0
APPLICATION APPROVAL
This application is not a pern-dt Until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
F7LE