680316.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Iieavy Lines
AMID (OR NA6MZ Or BUSINESS)
MAILING ADDRErs
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NAME
ADDRE118
CITY TELEPHONE NUMBER
NAME
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CITY I TELEPHONENUMBER
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NEW
ADD
ALTER
REPAIR
NUMBER OP S
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PROPOSED. Us,
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RESIDENTIAL LINE
NON-RESIDENTIAL -❑ SIGN
RETAINING
DEMOLISH a WALL
EXCAVATE FENCE
OR FULL („»„..5.„„.....Fl.)
PRE -MOVE SWIM
1 l INSP. M POOL
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I hereby acknowledge that I have read this application; that the in-
formation given in 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.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
stall be completed in ninety days; MOVED -IN BUILDINGS shall be oom-
pleted In six montha.)
71111Z F
NOTE: Applicant Subject to Plan Check Fee
This Permit covers
work to
be dose
on private property ONLY.
Any construction on
the public
domain
(curbs, sldewalks, driveways,
marquees,
eta.) wi8
require
separate permission.
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EXISTING STREET R/W ._„..„...g"P.
COMP. PLAN ST. R/W ...„..„...PT.
■ ■
Plan Check No...__.._._.„
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17��:�'3TCe1z/a Ie : y: HY e u
EXCAVATION OR
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
EM
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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