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ENT I Applicant M
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Li - 0 1 " SIGN I
r—� NEWD I DEMOLISH I M FENCE I
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR r! ON-RE.,D,NTAL UNITS
I hereby acknowledge that I have read thin application; that the in-
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with City L and state lawn 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 Umit One Year be completed In ninety days.)
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114014
NOTE: Applicant Subject to Plan Check Fee
This permit coven work to be do a onprivate Property ONLY.
Any construction on the public domain (curb*, sidewalks, drivewaYn,
rnarquees, etc.) will require separate permission.
[] YES 0 NO
BUILDING
VALUATION
BUILDING PTIRKI
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LIN
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT I=
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
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