650219.pdfBuilding Permit Application jx.,,,Jc"H`eav`y TIL c
NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
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PERMIT
650219
NUMBER
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REAR YARD
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MAP NUMBER
VACANT SITE
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ING AREA
LOT AREA
VARIANCE NUMBER
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ALL BUILDING SETBACKS ;W
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I hereby acknowledge that I have read this application; that the in
formation given to 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 parson
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
SIGNAT M (OWNER OR AGENT) DATE SIGNED
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�7L-G-T PLA�N CHEC" APPROVED
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PERM�JUXBER
TYPE OF CONSTRUCTION STREET 1Wr1WVXD
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NO. OF BLOCS.
PER113LDG.
TOTAL ;XIE Z
BUILDING
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VALUATION
2
BUILDING PERMIT
FEE
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PLUMBING
3
PERMIT FEE
4
HEAT & GAS LINE
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PER311T
This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
tion, or his deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space provided.
INSPECTION
DIRECTOR'S SIGNATURE
DEPARTMENT
CITY OF
MANE
EDMONDS
Pit 0.1107
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