650054.pdf5
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WrBuilding
Permit
Application
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NAME (OR NAME OF BUSINESS)
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AUMILaNG ADDRESS
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TELEPHON
IF11H PERMIT
NUMBER 650054
Lines
JOB
B
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SI SET BACY REAR YARD
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USE ZONE MAP NUMBER VACANT 81TN
0 YES NO
13
NUMBER
BUILDING AREA LOT AREA VARIANCE
_ B I
H F.11 0 H T ALL BUILDING SETBACKS N
NOTE: TO EAVE LINES
Required
[] YES [] NO
[] YES [3 NO
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NO. OF ULD05.
PERIBLDG.
BUILDING
VALUATION
2
BUILDING PERMIT
FEE
NEW
ADD
DEMOLISH
NUMBER OF STOIRUIES
3
1
PLUMBING
PERMIT FEE
HEAT & GAS LINE
PERMIT FEE
ElALTER
1:1 REPAIR
1:1 RESIDENTIAL
1 1:1 NON.RESIDENTrAL
NUMBER OF 4
DWELLING
UNITS
1 5
DEMOLITION
PERMIT FEE
PROPOSED USE
_7 1
6
AMOUNT DUE
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-
ATTENTION
APPLICATION APPROVAL
lzed 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
AUTHORIZES
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 acknowledged in space provided.
1IGNATURE (OWNER OR AGENT) DATE SIGNED
t'j (-C'z ' �S'
,OT PLAN QII CK & APPROVED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
R �C�R-s SIPWURE
DATE
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