690317.pdfBUILDING DEPARTMENT Applicant Fil1
PERMIT APPLICATION Inside 11cavy Lines
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REPAIR
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4UMBER OF STORIES
I NUMBER OF
DWELLING
UNITS
KROLL MAP NO.: PERMIT
NUMBER 69,0317
[3 YES
13 NO
EXISTING'STREET n/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W ............ FT- ............ IT.
TYPE
C] YES [] NO
Plan Check No.
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-PLOT PLAN (Indicate Building setbacks, abutting streets)
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PRE -MOVE INSPECTION
XCAVATION OR FILL
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ITOTAL
AMOUNT DUE
I hereby acknowledge that I havo read this application; that the In-
formation given Is 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-
ATTENTION
lating construction: and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of WaAhington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEIMOLITIONS which
WORIC NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in mix months.)
DATE ffiGNED
INSPECTION
DEPARTMENT
CITY OF
ED51ONDS
NOTE: Applicant SiibVct to Plan Check Fee
I'R 0-1107
Thin Permit c0vPr8 work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees. etc.) will require sepwate permission.
Valuation
[] YES [] NO
A
No.
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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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