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ING DEPARTMENT AppHcant FIR
ITAPPLICATION Inside Heavy Lines JOB ADDRESS
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PLOT PLAN APPROVED
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REMARKS
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REMARKS
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METER SIZE SERVICE 8:
CITY TELEMONE NUMBER
REMARKS
STATE LICENSE NUMBER CITY IACENUE NUMBER
I E CONNECTION
Legal Description of Property (Show Below or Attach Four Copies)
PERC. TEST
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SIGN
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DEMOLISH
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FENCE
0 ALTER
RESIDENTIAL
NUMBER OF
REPAIR
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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 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.
ll,,,,t Demolitions which shall
NOTE: Permit Limit One Year be completed in ninety days.)
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SIGNATURE wril-jit OR AGENT) E si
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NOTE: Applicant Subject)o Plait Check Fcc
OF
[] YES 0 NO
BUILDING
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VALUATION
BUILDING PERMIT
2
FEB
PLUMBING
3
PERMIT FEE
BEAT & GAS LINE
4
PERMIT FEE
SIGN PERMIT
5
FEE
DEMOLITION
6
PERMIT FEE
PLAN CHECK
7
FEE
8
AMOUNT DUE
ATTENTION
Tills PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
PERMIT
NUMB
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YES NO 0
VARIANCE MBER
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0 YES
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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.
-This I -emit covers work to be done on private property ONLY.
Ally construction on the public domain (curbs, sidewalks, driveways. FILE
msrquees, etc.) will require separate permission.
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