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RESIDENTIAL
.1U 3ER OF
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NON-RESIDENTIAL
I UNITS 60_1�1
I hereby acknowledge that I have read this application; that the In-
formation given In 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.
NOTE: PERMIT LIMIT ONE YEAR
PLOT
FILE
V4
5--
Required
NO
[3 YES
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 0-1107
640324
NUMBER
-------- ----
I NUMBER VACANT SITE
// 3 /t/ " 5 0 NO
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
rv-a I o YES o NO
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APPLICATION APPROVAL
This application Is not a pernitt 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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