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OUILUIMU DEPARTMENT Applicant Fill
PERMIT APPLICATION I Inside Heavy Lines
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GAS
❑ NEW LNRESIDEENTIALElLINE
NTIAL ❑ SIGN
ADD ❑ DEMOLISH RETAINING
NINE
❑ ALTER ❑ ORFILL EXCAVATE
❑ FENCE x.......... Ft.)
❑ REPAIR ❑ PRE -MOVE SWIM
INSP.❑ POOL
DWELLING
UNITS
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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 -
Bed 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.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IIGNATURE (OWNER OR AGENT) _ I DATE SIGNED
NOTE: Applicant Subject to Plan Chech Pee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
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5-
710330
❑ YES
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W ............FT. ............FT.
REMARKS
❑ YES ❑ NO
❑ YES ❑ NO
THIS SITE IS LOCATED IN TH
CITY OF EDMONDS. i nr.Ai SAI
TAX SHOULD BE CODED 31.0,
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Plan Check No .....................
Valuation
Fee
Receipt No.
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BUILDING
PLUMBING
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HEAT A GAS LINE
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FENCE
SIGN
RETAINING WALL
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT - This application is not a permit until
AUTHORIZES elgned by the Building Official or his Dep-
ONLY THE
{CORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DIREC OR'S Sf NATUIj "
DEPARTMENT
CITY OF
EDhIONDS DATE
PR 0-1107
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