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NUMBER
NAME
ADDRESS
CITY
ONE NUMBER
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JCDDRESS
CITY
TELEPHONE NUMBER
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LICEN13E NUMBER
CITY LICENSE NUMBER
Legal escri tion of Property (Show Below or Attach Four Copies)
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REAR YARD SETBACK
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USE ZONE
LOT AREA VACANT SITE
1 0 YES 0 NO
[KI�GHT�
�BUMILDI A VARIANCE 14UALU�"
'LOT PLAN APPROVED
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LEMARKS
11EMARKS
METER SIZE SERVICE SIZE LEARANCE CHECKED BY
REMARKS
TYPE CONNECTION
VERIFIED 13Y
PERO. TEST
PERMIT NUMBER
WM�� 7.nwm I TYPE OF CONSTRUCTION STREET IMI-novAW
[3 YES
111iEW I
L_j SIGN
A,DD I
DE20LISH
FENCE
ALTER
RESIDENTIAL
NUMBER OF
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F-1
REPAIR
12-
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NON-RESIDENTIAL
DWELLING
I UNITS
I hereby acknowledge that I have read this 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 and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in vlo:ation of the Labor Code of the State of Washington
relating to Workmen's Compensation insurance.
1111,11 Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
9 — -3- - ID to
NOTE: Applicant Subject to Plan Check Fee
This PC mit covem work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, drIvewaym.
MWqjjce,g, Cie.) will require separate permission.
0 NO
BUILDING
I
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
81 AMOUNT DUE
AT=NTION
This PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
Pit a-1107
[3 YES 0 NO
TOTAL
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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 acknowledged In space provided.
FILE
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