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formation given (s correct; and that I am the owaer, or the duly author.
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This Permitcovers work to be done on private property ONLY.
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REQUIREMENTS
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CITY TELEPHONE NUMBER
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NAME
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REMARKS
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES
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UNDERGROUND ❑ YES
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PLAN CH EG ED BY THIS SITE IS LOCATED IN THE CITY
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1 hereby acknowledge that I have read this application; that the in-
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formation given (s correct; and that I am the owaer, or the duly author.
(zed agent of the owner. i agree to comply with city and state laws reg.-
latln6 corunmetlon; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the elate of Wasbington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
This application Is not a permit until
NOTE: Permit limit One Year (Except DEMOLITIONS whichONLY
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signed by the Building Official or his Dep -
.hall be completed In Nnety days; MOVED -IN BUILDINGS shall be com.
WORK NOTED
uty; find fees are paid, and receipt is ac- �._-----
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knowledged In apace provided.
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CITY OF
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775.2525
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This Permitcovers work to be done on private property ONLY.
Any construction on thu public domain (curbs, sidewalks, driveways,
ORIGINAL - File YELLOW -. hlspector
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marquees, etc.) will require separate permission.
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