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PERhIIT
NUMBER 650093
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VACANT SITE
YES [3 NO
VARIANCE NUMBER
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NOTE: TO EAVE LINES
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Encroachment Permit F49RMIT NUMBER
Required
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NEW
DEMOLISH
UMBER OF STORIES
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RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWELLING
UNITS
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-
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
PLOT
FILE
C] YES [3 NO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHOR][ZE8
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
OF
0
0 YES 0 NO
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 aelmowledged in space provided.
DIRECTOWS SIGN"URE
3