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NAME
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NAME
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Applicant Fill PL
BUILDING
PERMIT 650 135
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BUILDING AREA
LOT AREA VARIANCE NUMBER
ALL BUILDING SETBACKS
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HEIGHT
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NO. W1 BLOG9. PORIBLD0. TOTAL FRE Z
BUILDING
VALUATION
BUILDING PERMIT
NUMBER OF STORIE 2 FEE
Q EW DEMOLISH PLUMBING Z
3 PERMIT FEE
11eADD I HEAT & GAS LINE
ALTER RESIDENTIAL NUMBER OF 4 PERMIT FEE
DWELLING
REPAIR NON-RESIDENTIAL UNITS DEMOLITION
5 PERMIT FEE
6 AMOUNT DUE
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I hereby acknowledge that I have read thin application; that the In-
formation given is correct; and that I am the owner, or the duly author. ATTENTION APPLICATION APPROVAL
[zed agent of the owner. I agree to comply with city and state laws regu- THIS PERMIT This application is not a permit until
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec-
relatIng to Workmen's Compensation Insurance. 1*vORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR receipt Is acknowledged in space provided.
SIGNATURM (OWNER 0 INSPECTION
Mir OR 0 A NT) 1JAT4 MIUNEL) DIRECTOR'S SIONATU
DEPARTMENT
CITY OF
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PLOT PLAN CHECK & APPROVhD, EDMONDS
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