640289.pdfApplicant Fill PERMIT
Inside Heavy Lines NUMBEit 640289.
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LOT AR VARIANCN NUMBER
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ALL BUILDING SETBACKS
NOTE: TO EAVB LINES
TELEPHONE NUMBER
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MEE—PHONE NUMBER
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UTE—FR SIZE SERVICE SIZE
STATE LICENSE NUMBER
Ci LICENSE N MEER
REMA L13
r.OT I BLOCK
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[:] YES [j NO
T
PLUMBIN
NEW DEMOLISH
N MEER OF STORIES
ADD
—
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
ALTER RESIDENTIAL
NUMBER OF
4
REPAIR NON-RESIDENTIAL
DWELLING
UNITS
5
DEMOLITION
PERMIT FEE
I ff_O�POSEDUSE
-
6
AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ATTENTION
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,
THIS PERMIT
latIng construction; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed in 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
'WT—,---A—Eg--I DATE 8 NED
SIGNATURE (QWNj�]% OR AGP T) DATE S�G
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
CHECK, APPROVED
I ��&
PR 0-1107
FILE
0 YES 0 NO
I No. OF 13LOGS: PERIOLDO. TOTAL FES
I I 1� I I __
APPLICATION APPROVAL
This application is not a permit unti
signed by the Director of Bu ' ilding Inspec
tion, or his deputy; and fees are paid, an
receipt is acknowledged in space provided
DIRECTOR'S - SIGNiA74RE
dg. Official
DATE
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