650094 (2).pdfQ
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BESS
SIDE YARP
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TELEPHONE NUMBdIYER
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BUILDING ARE_�
HEIGHT
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A
STATE LICENSE NUMBER CITY LICENSE NUMBE
LOT BLOCK TRACT
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NEW DEMOLISH NUMBER OF STORITE
ADD
ALTER RESIDENTIAL NUMBER Or
DWELLING
REPAIR NON-RESIDENTIAL I UNITS
RE NA L
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 Workman's Compensation Insurance.
NOTE: PERMIT LIMIT ONE YEAR
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FILE
0 YES CJ NO
BUILDING
I
Vj�LUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR
PERMIT 650094
NUMBER
ET BACK REAR YARDI
IAP NUMBER VACANT SITE
0 YES (3 NO
.OT AREA VARIANCE NUM13ER
ALL BUILDING SETBACKS
NOTE: TO BAVE LINES
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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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