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BUILDING DEP11IRTMENT Applicant M
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FPERMIT APPLICATION JOB ADDRES13
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/ (OR NAME OF BUSINESS
2
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TELEPYONE NUMB]
'e., W_ I 'I e
TY LICENSE NUN
or Attach Four Copies
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NEW
SIGN
NUMBER OF STORIES
M
ADD I
DEMOLISH
FENCE
I
ALTER
RESIDENTIAL
NUMBER OF
REPAIR
NON-RESIDENTIAL
DWELLING
I UNITS
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-
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 Workmen's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
IIGNATURE (OWNER OR AGENT) DATE SIGNED
g;//' "/
NOTE: Applicant Subject to Plan Check Fee
This Pernilt covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, drivewayn,
marqueen, etc.) will rrquire separate permission.
BUILDING
PERMIT
NUMBER 660029
I [I YES [3 NO 0
HEIGHT BUILDING AREA VARIANCE NUMBER I
PLOT PLAN APPROVED 104
or
0 YES [3 NO
VALUATION
[I YES [3 NO
BUILDING
1
VALUATION
Z
BUILDING PERMIT
2
FEE
3
PLUMBING
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
2,
SIGN PERMIT
5
M'. E
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7�
FOE
8
AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a pernilt until
AUTHORIZES
signed by the Director of Building Inspec-
ONLY THE
WORK NOTED
tion, or his deputy; and fees are paid, and
receipt is aelmowledged in space provided.
INSPECTION
DEPARTMENT
DIR7E;cTOR'8 HE
CITY OF
EDMONDS
PR 6-1107
FILE