660532.pdfBUILDING DEPARTMENT Applicant Fill.
"TERMIT APPLICATION Inside Heavy Un.
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TELEPHONE NUMBER
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CITY TELEPHONE NUMBER
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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SIGN NUMBER Or BTORIEE
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NEW F
A ADD I DEMOLISH FENCE
ALTER RESIDENTIAL NUMBER OF
DWELLING
REPAIR NON-R UNITS
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I hereby acknowledge that I have road 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 violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
IEzlepl Demolitions which 8hall
NOTE: Permit Limit One Year be completed In ninety days.)
s N URE W It :O;R GENT) DATE SIGNED
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NOTE: Applicant Subject to Plan Check Fee
Thin Permit covers work to be dono on private property ONLY.
Any construction an the public domain (curbs, midewallim, drIvewaym,
marquees, etc.) will require separate pernilmsion.
BUILDING
PERMIT 32
/ / 5 h; I NUMBER 6605")
FOB ADDRESS
G 7
RIDE YARD SETBACK STREET SETBACK REAR YARD SETBACK
7
USE ZONE� LOT AREA VACANT SITE
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HEIGHT I BUILDING AREA VARIANCE NUMBER
PLOT PLAN bXPROXED 10
0 YES
I I VALUATION
BUILDING P�AUIIT
2 1
FEE
rLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
TPLAN
CHECK
IFEE
81 AMOUNT DUE
ATTENTION
This PERMIT
AUTHORIZES
ONLY TIM
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDAIONDS
PR 0-1107
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PERMIT NUMBER
0 YES 0 NO
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APPLICATION APPROVAL
This application Is not a perinit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is aclmowledged In space provided.
FILE
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