650451.pdfON
POSTED ON KRO MAP NO.:
BUILDING
PERMIT
U,ILDING DEPARTMENT
AppHCaBt OR
INUMBER
650451
PERMITAPPLICATION
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STATE LICENSE NUMBER
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Legal Description of Property (She low or Attach Four Copies)
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FIRE ZONE TYPE OF CONSTRUCTION STREWW 12drnUVED
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SPECIAI U EUXUK REQUIRED
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OCCUPANCY GROUe
PLAN CHECKED By
VALUATION
TOTAL 1199
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VALUATION
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WORK TO BE DONE
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BUILDING PERWaT
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PERMIT FEE
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BEAT & GAS LINE
PERMIT FEE
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OF STORIES
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SIGN PERMIT
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DEMOLITION
PERMIT FEE
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REPAIR NON-RESIDENTIAL UNITS
PLAN CHECK
7 FEE
PROPOSED USE
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8 [AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given Is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating coastrUCUOU; 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.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
ATTENTION APPLICATION APPROVAL
THIS PEnMIT This application is not a permit until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
WORK NOTED tion, or his deputy; and fees are paid, and
receipt is acknowledged In space provided.
INSPECTION I CTOR'S 87 TURE
DEPARTMENT
CITY OF
LTF.
EDNIONDS
Pit 6-1107
I
81 ATU (OwNEjh OR AGENT)
NOTE: Applicant Snbj h
FILE
This Permit mvers work to be done On Private property ONLY.
Any construction on the public domain (curbs, sidewalks, drIvewaym,
""Ores, etc.) will require separate Peemi"NIOO-
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