650044 (2).pdf9.
a
Iding Permit Applicatioi
ME (OR NAME OF BUSINESS)
6'. 4, Y/-9^1 S, C— /V
ILING ADDRESS
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(-A
a
I P;V(. 4, —1
Applicant Fill.
Inside Heavy Lines
/�� 7- 7 4 SA. -
-7 —
E; YARD
P ZONE
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Required
NEW
DEMOLISH
I
ADD
ALTER
RESIDENTIAL
NUMBER OF
I
REPAIR
NON-RESIDFNTIAL
DWELLING
I UNITS
I hereby ,cknowledge that I have read this application; that the In-
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-
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
rotating to Workman's Compenration Incurance.
NOTE: PERMIT LPIT—_ONE� YEAR
rj—G—NATURE (OWNER 0 AGENT) 'Tl-.' SIGNED
Elf," 1 1) - �1) -
FILE
NO
0 YES
---- ----- - —
= ITE
[3 NO
NUMBER
ALL BUILDING 13ETBACKS
NOTE: TO EAVE LINES'
0?
BUILDING
I
VALUATION
BUILDI qG PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
a
AMOUNT DUE
AT=NTION
TIUS PERMIT
AUTHORIZES
ONLY TILE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
PR 6-1107
PERMIT
NUMBER
5ACK
.-I � / 71--
is
Z
OQ
VL &
Wr_1
MIT NUMBER
�MT AMIMPROVI
STRE
0 YES [3 NO
APPLICATION APPROVAL
This application is not a pernilt until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is acknowledged in space provideq.
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