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�.A POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION
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4UMBER OF STORIES
NUMBER OF
DWELLING
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given to correct; and that I am the owner, or the duly author-
lzed 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
ATTENTION
will be employed in violation of the Labor Code of the State of Washington
THIS I-ER311T
relating to Workmen's Compensation Insurance.
AUTHORIZES
N imit 0 e& (Except DEMOLITIONS which
PepleTte,d
ONLY THE
WORK NOTED
OTITT:
IRnety da� _D-IN BUILDINGS ahall be com
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y pt�
plete94"Six months.)
N UILE (OWNER OR 7AT)
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DAT? SIGNED
3 7 145
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INSPECTION
DEPARTMENT
CITY OF
Ll EDMONDS
NOTE: Applicant Subject to Plan Chcck Fce
PR 6-1107
This I -emit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalksp driveways,
marquees, etc.) wilt require separate permission.
DEFICIENCY THIS PROPERTY
Valuation
BY
C] YES marcr—
Fee
No.
1/5--zilo 1 L 5-6 -5-4
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
imowledged in space provided.
FILE
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