650293.pdfPOSTED
ON R-R—OLL MAP NO.:
650293
.BUILDING DEPARTMENT Applicant FLU
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PERMIT APPLICATION Inside Heavy Lines JOB
ADDRESS
NAME (OR NAME OF BUSINESS)
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STREET SETBACK
REAR- YARD SETBACK
SIDE
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VARIANCE NUMBER
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METER SIZE
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CITY LICENSE NUMIS�;
TYPE CONNECTION
ZPERMIT
:ription Of Property (Show Below or Attach Four Copies)
PERC. TEST
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FIRE ZONE TYPE OF CONSTRUCTION STREET I
NEW
Lj SIGN
ADD
DE2 FENC
QALTER
F/ RESIDENTIAL
NUMBER OF.
REPAIR
1 1:1 NON-RESIDENTIAL
DWELLING
UNITS
I hereby acknowledge that I have read this application; that the In-
formation given Is correct: and that I ant the owner, or the duly author-
lzed agent of tho 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.
IE,,,pt Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
-A
NOTE: Applicant Snbject to Plan Check Fee
Thin permit covers work to be done on private property ONLY.
Any construction on the public domain (curbo, sidewallim. driveways,
marquees. etc.) Ivill require meparnti- Permission.
0 YES [] NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
PERMIT FEE
PLAN CHECK
7
FEE
8 1 AMOUNT DUE
ATTENTION
THIS PERAUT
AUTHOTUZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
1-11 6.1107
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[3 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.
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