660518.pdf�i
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BUILDING DEPARTMENT I Applicant
PERMIT APPLICATION Inside Heavy Lines
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LING ADDRESS 7
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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n ALTER I RESIDENTIAL I NUMBER OF
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REPAIR NON-RESIDENTIAL UNITE LING
I hereby acknowledge that I have read thin application; that the in-
formation given to 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 Workmen's Compensation Insurance.
• (Except Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
!1GNATURE (OWNER OR AO T) DATE IGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers
work to
be done
on private property ONLY.
Any construction on
the public
domain
(curbs, sidewaiha, drh•eways,
marquass,
etc.) will
require
separate permission,
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VALUATION
BUILDING
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DEMOLITION
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ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
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660518
NUMBER
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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 t
receipt is acknowledged in space provided.
INSPECTION DIRECTOR'S SIGNA U I
DEPARTMENT
CITY OF
EDMONDS
PR e-1107
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