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BUILDING DEPARTMENT
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CITY
D ON KROLL MAP NO.: BUILDING
POSTE PERMIT 6604-IT 0
Applicant FIR NUMBER
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7j�e_gal Description of Property (Show Below or AU&Cn 00�
C. TEST
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FIRE ZONE TYPE 01
SPECIAL INSPECTOR R
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0 YES [] NO
PLAN CHECKED 13Y
0
BUILDI;G
WORK TO BE DONE
1 VALUATION
BUILDING PERMIT
2 FEE
PLUMBING
3 PERMIT FEE
HEAT & GAS LINE
4 PERMIT FEE
i -NUMBER OF -STORIES
SIGN PERMIT
NE SIGN
5 FEE
DEMOLISH FENCE
DEMOLITION
0
NUMBER OF
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6 PERMIT FEE
ALTER RESIDENTIAL
—
I DWELLING
REPAIR NON-RESI UNITS
PLAN CHECK
7 FEE
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I hereby acknowledge that I have read this application; that the in-
ATTENTION
given to correct; and that I am the owner, or the duly author-
formation
Ized agent Of the owner. I agree to comply with city and state laws ngu-
THIS PERMIT
lating construction; and in doing the work authorized thereby, no person
AUTHORIZES
will be employed in violation Of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Imurance.
WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit One Year be completed In ninety days.)
A —
W, ORE (OWN AG T) L)ATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
ED31ONDS
NOTE: Applicant Stibject to Plait Check. Fee
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it to be done on privnte property ONLY.
Any construction on Ole publie domain (curbst Kidewelks, drivewayst
marquees, etc.) will require separate pernil"mion.
YES
0 NO 0
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13 YES 13 NO I I
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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.
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