650082 (2).pdf9
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1 71111,01? F —=TER
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NEW Lj DEMOLISH
MALTER
Q—__kESIDENTIAL
NUMBER OF
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REPAIR FI NON-RESI
DWELLING
UNITS I
I hereby acknowledge that I have read this application; that th In-
formation given in correct; and that I am the owner, or the duly al0r-
Ized agent of the owner. I agree to comply with City and state laws regtl�
luting construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor "s of the State of Washington
relating to Workman's Compensation insurance.
NOTE: PERMIT LIMIT ONE YEAR
-1/-6
jj YES
[] NO
BUILDING
I
vALUATION
BUILDING PERMIT
2
FEE
PLUM13ING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMO TION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
TIMS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
I
50082
YE13
ALL BUILDING SETBACKS
NOTE: TO EAVM LINES
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[j YES 13 No
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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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