660200.pdfFB;UILDIN:G DEPART MENTLA
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PERMIT APPLICATION Ide Heavy Lh
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NAME
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WO?TO BE DONE
0 A/ S-fR V C. A/045
SIGN
NEWD I DEE28HI H PENCE
14 0
ALTER RESIDENTIAL NUM ..... or
DWELLING
M REPAIR F-1 NON-RESIDENTIAL UNITS
J—
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 Workman's Compensation Insurance.
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
::41— 4 ro
NOTE: APPlicant Subject to Plan Cbeck Fee
—jW_s permit covers work to be done on private Property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
,L MAP NO.:
PERMIT
NUMBER
P- '44� W.
� 6
[] YES 0WO
BUILDING
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
AT=NTION
THIS PERMT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAXONDS
PR 6-1107
660200
-.06
REAR TARP, BEWISAUM
/j
VACANT SITE
0 YES [3 NO
VARIANCE NUMBER
[3 YES
WAi
13 NO
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APPLICATION APPROVAL
This application is not a perntit 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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