660539.pdf-----------
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAMM OF BUSINESS)
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MAILING ADDRESS
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CITY T.
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NAME
ADDRESS
CITY T
NAM
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ADDRESS
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STATE LICENSE NUMBER C
Legal Description of Property (Show Below or
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Applicant Fill
Inside Heavy Lines
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NEW
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SIGNS
ADD
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DEMOLISH
rX[:jl FENCE
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RESIDENTIAL
NUMBER OF
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F� REPAIR
11:1
F-1 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 lawn 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.
ll,,,,l Demolitions which shall
NOTE: Permit Limit One Your be completed in ninety days.)
FIG -NATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant SnIliect to Plan Check Fcc
Thin Permit covers work to be done on private property ONLY.
Any construction on tile public domain (curbs* sidewalks. drivewnys,
marquees, etc.) will require separate permisalon.
0 YES
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r KROLL MA 0.: BUILDING
7a, Pf PERMIT bbO577
I NUMBER I
13 NO
BUILDING
1
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
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORIT NOTED
INSPECTION
DEPARTMENT
CITY OF
EDBIONDS
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[] YES 13 NO
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YES 13 NO
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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.
DIRECTqR'S SIGNATUIJU 1-
FILE
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