660074.pdfPOSTED
ON KROLL MAP NO.:
BUILDING
BUILDING
DEPARTMENT Applicant Fill
PERMIT
NUMBER
660074
PERMIT
APPLICATION ]Inside Heavy Lines
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VARIANCE NUMBER
NAME
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PLAN APPROVED
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REMARKS
CITY
TELEPHONE NUMBER
NAME
REMARKS
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ADDRESS
METER SIZE SERVICE
SIZE
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CITY
TzLisruvriju NUMBER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TYPE CONNECTION
VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST
PERMIT NUMBER
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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 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.)
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NOTE: Applicant Snbject to Plan Check Fee
_ihl, Permit mvr� work to be done on private property ONLY.
Any "Instruction on the public domain (curbst sideivallimo drivewaysp
marquees, etc.) will require separate permission.
[3 YES
1 1 VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
1611
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
FEE
81 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDIVIONDS
Pit 6-1101
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06
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APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt Is aelmowledged in space provided.
FILE