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640395
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PLAN FILE NUMBER
AD '1'� E
BUILDING
Fill
Fill
PERMIT
Line,,
Lines
NU
NUMBER
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JOB ADDRESS
A D DR
SIDE YARD
SET BACK
REAR YARD
VUSE
7'
BER
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MAP NUMBER'
VACANT SITE
0 YES 0 NO
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UILDING AREA
LOT AREA
VARIANCE NUMBER
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Required
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PET IMPROV,
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NO. OF MILOGS.
PERIBLOO.
TOTAL FRI
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0
BUILDING
VALUATION
BUILDING PERMIT
FEE
'?2-.D 0
ErNEW
1:1
El DEMOLISH
INUMBER OF STORI ES
2
2
3
3
PLUMBING
PERMIT FEE
-
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RESIDENTIAL
4
NUMBER OF 4
HEAT & GAS LINE
PERMIT FEE
1:1 REPAIR
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NON-RESIDENTIAL
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UNITS
5
5
DEMOLITION
PERMIT FEE
IMPOSED USE
4 6
6
AMOUNT DUE
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I hereby acknowled;e that I have read this application; that the i't
formation given Is correct; and that I am the owner, or the duly author-
ATTENTION
APPLICATION APPROVAL
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.
THIS PERMIT
AUTHO'AlIZES
ONLY THE
WORK NOTED
This application Is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is aclmowledged In space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
RNE7 1
?LOT PLAN CHECK & APPROVED
INSPECTION
DEPARTMENT
CITY OF
EDATONDS
DIREC!rO� GNATURE
e�
DATLI
PR 6-1107
F71LE
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