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BUILUMU
M- PLAN FILE NUMBER
PERMIT
pplication In Applicant Fill NUMBER 640425
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TELEPHONE NUMBI�11 USE ZONE
YES NO 0
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BUILDI14G AREA LOT AREA VAKLINCE NUM13ER
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HEIGHT ALL BUILDING SETH CKS
NOTE: TO EAVE LINES
TN"PHUNE NUMBER REMARKS
STREET —GRADE CHECKI.
Encroachment Permit PERMIT NUMBER
Required
n- YES n NO
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TN ONE NUMBER METER SIZE SERVICE bILN ICHECKED BY
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�TATE LaCENW9 NUMBER CITY LICENSE au=. -I, REMARKS
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TYPE CONNECTION VERIFIED BY
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PERO. TEST PERMIT NUM13ER
FIRE ZONE__rPE 112' CONSTRUCTION STREET imeituVED
T I [] YES [3 No
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NEW DEMOLISH
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ALTER
REPAIR RESIDENTIAL NUMBER OF
E DWELLING
REPAIR NON-RESI UNITS
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I hei;'69by acknowledge that I have read this application; that the In-
formation given In correct; and that I am the owner, or the duly allthDr-
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
FILE
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4.1
PERMIT FEE
DEMOLITION
5
PERMIT FEE
61 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
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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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