660421.pdfApplicant Fill
PERMIT APPLU Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
A/2
CITY TELEPHONE NUMBER
0 7
/Y) 0 74
NAME
I yr [A-DDRES
CITY
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TOLEPRON
CITY LICE
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I hereby acknowledgd that I have road this pplication; that the In-
formation given In correct; and that I am the 0�duer, 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 Workmeas Compensation Insurance.
(Ex opt Demolitions which shall
NOTE: Permit Limit One Your bay completed In ninety days.)
r
I NOTE: Applicant Subject to Plan Check Fee
This Perniat covers work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewaYs.
nutrquees, etc.) will require fleilnrflitC permission.
PERMIT
/ / --/ �"el I NUMBER
RESS
RD SETBACK I STREET SETBACK
a I AMOUNT DUE
ATTENTION
TIUS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6.1107
I
660421
ZkR YARD 8
R
vAcANT SITE
13 YES Er,
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.
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