650434.pdfMATTING ADDRE1111
CITY
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NAME
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CITY TELE ONE NUMBER
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STATE ACENSE NUMBER
CITY LICENSE 14UM
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Legal Description of Property (Show Below or Attach Four Copies)
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ONE LOT AREA VACAINr SITE
0 YES [3 NO
.1AIMCNCE NUMBER
UGHT JUIEA
,OT PLAN APPROVED
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@MARKS
MARKS
PE CONNECTION VERIFIED BY
RC. TEST PERMIT NUMBER
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C] YES
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El SIGN
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ADD
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SRI
DEMOLI D FENCE
ALTER
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RESIDENTIAL
NUMBER OF
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REPAIR
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NON-RESIDENTIALI
DWELLING
UNITS
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.
ized agent of the owner. I agree to comply with city and state laws "gu-
iating 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.
(Except Demolitions which shall
NOTE: Permit Mmit One Year be completed in ninety days.)
NOTE: Applicant Stibject to Plan Cbeck Fec
-This I -emit mvm work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
BUILDING
1
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
FBI,
a I AMOUNT DUE
AT=NTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
()ITY OF
EDMONDS
PR 6-2107
[] YES 13 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 aelmowledged in space provided.
FILE