640342.pdfS.0
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nt FLU
Applicant FLU
cationi
PER] IIT
NUM S BER
640342
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Inside IIcavy
JOB ADDRESS
ILInes
SIDE YARD I
bN'Ll 13ACK
REAR YA
_S'
_7
74
TELEPHONE NUM
USE ZONE
MAP NUM13EIC
VACA N
0 YES [3 NO
'31
UIRLDING�AIIEA
LOT AREA
vA�^NCE NUMBER
tS
r:_.77_7�F
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7r7-, r-
NEW DEMOLISH
ADD I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR N1 UNITS
S7�C_
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-
lzed agent of the owner. I agree to comply with city and state laws regu-
latlng constructiOn: and in doing the work authorized thereby, no permon
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
� P// 1614
FILE
ALL BUILDING SETBACKS
NOTE: TO EAVE LINES
Encroachment Perml PERMIT NUMBER 8TjtNNr
Required
M YES f-1 NO
[3 YES E3 NO
[:] YES [] NO
No. OF BLOOD.
PERIBLOG..
TOTAU FEZ
BUILDING
VALUATION
62,40-a
BUILDING PERMIT
2
FEE
FLUM13ING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
AMOUNT DUE
6-
ATTENTION
APPLICATION APPROVAL
THIS PERMI[T
This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is aclmowledged in space provided.
INSPECTION
DIREC
DEPARTMENT
I k va k-, Idg. official
CITY OF
EDMONDS
— DAT3�-
16
PR 0.1107
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