640443.pdfq
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PERMIT
640443
NUMBER
211
117 _4
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REAR YARD
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VACANT SITE
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,OT AREA
VARIANCE NUMB
ALL BUILDING SETBACKS
NOTE:
TO EAVE LINES
7
[j YES [] No
WORK TO BE DONE j"-(
NO. OF BLOOD. PERIBLOG. TOTAL Fee
BUILDING
1 VALUATION
BUILDING PERMIT
NUMBER OF STORIE 2 FEE
S
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NEW
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PERMIT FEE
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PERMIT FEE
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RESIDENTIAL
1 0 '
E NON-RESIDENTIAL
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UNITS
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
I hereby acknowledge that I have read thin application; that the in.
ATTENTION
APPLICATION APPROVAL
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
This application is not a permit until
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
signed by the Director of Building Inspec-
will be employed in violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR
receipt is acknowledged In space provided.
INSPECTION
lIGNATURE (OWNER OR AGENT) DATE IGNE
13�1�',13 SIGNATURE
DEPARTMENT
7//
I C-L
CITY OF
F
DATE
EDMONDS
L,OT PLAN CHECK & APPROVED
PR 0.1107
FILE
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