640129.pdf----------
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F Fill PERMIT
Lines NUMBER 640129
JOB ADDRESS
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JOB ADDREI
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SIDE YA SET BAC!� REAR YARD
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3 31'a
kat USE ZONE MAP NUMBER VACANT SITE
PY�ES 0 NO
BUILDING AREA LOT AREA VARIANCE NUMBER
HEIGHT ALL BUILDING SETBACKS
I NOTE: TO EAVE LINES
Required
n- YES
METE�t E
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BUILDING
VALUATION
I
BUILDING PERM T
FEE
NUMBER OF HT—ORIES 2
NEW
El DEMOLISH
PLUMBINb
ADD
3
PERMIT FEE
ALTER
S___��SIDENTIAL
NUMBER OF
4
HEAT & GAS LINE
PERMIT FEE
1:1 REPAIR
E] NON-RESIDENTrAL
DWELLING
UNITS
—
5
DEMOLITION
PERMIT FEE
PROPOSED USE
—
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that th In-
formation given Is correct; and that I arn the Owner, or the duly Mor.
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
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
WORK NOTED
NOTE: PERA�IJ�LIMIT ONE YEAR
1IG URE 'OR AGENT A NED
INSPECTION
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DEPARTMENT
CITY OF
EDIVIONDS
PR 0-1107
FILE
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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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