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SIDE YARD SET BACK REAR YARD
TELEPHONE NUMBER _U_SEZONE MAP NUMBER VACANT Sff
0 YES
BUILDING AREA LOT AREA VARIANCE r
HEIGHT ALL BUILDING SETBACKS
TELEPHONE NUMBER REMARKS NOTE: TO EAVE LINES
Encroachment Permit PERMIT NUM13ER STREET GRJ
Required I I
Q_p F-1 DEMOLISH NUMBER OF STORIES
Q N-EW
ADD I
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ALTER
REPAIR
RESIDENTIAL
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NUMBER OF
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given in 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-
luting 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 Compenaatlon Immrance.
NOTE: PERMIT LIMIT ONE YEAR
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FILE
X
[] YES 0 NO
BUILDING
1
VALUATION
BUILDING PERMIT
2
FES
PLUMBING
3
PFRMIT FEE
BEAT
PERMIT FEE
DEMOLITION
5
PERMIT FEE
6
AMOUNT DUE
ATTENTION
THIS rERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
PR 0-1107
P,
0 NO
UMBER
0 YES 0 NO
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APPLICATION APPROVAL
This applirAxtion is not a perinit 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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