680497.pdfC:
BUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
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Applicant FM
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19 NAME
ADDRESS
CITY TELEPHONE NUMB
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esai Description ot rroperty (snow j3eiow or AM= ifour
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PL-ae, Le%- I S L-�:ss 4��4 14D
NEW
RESIDENTIAL
11
NON-RESIDEN
ADD
DEMOLISH
ElALTER
EXCAVATE
OR FILL
REPAIR
PRE -MOVIE
INSP.
GAS
LINE
SIGN
RETAINING
WALL
FENCE
POOL
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N
I
I hereby eaknowledge 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.
NOTE: Permit Limit One Your (Except DEMOLITIONS which
oha.11 be completed In ninety days; MOVIED-IN BUILDINGS "I be oarm.
pleted In six months.)
MrSAFM
NOTE: Applicant Subject to Plan Check Fee
This Perralt covers work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
masnuees, etc.) will reQuire bel)"A" permission,
I
d—
xisTING STREET R/W..__...FT.
COUP. PLAN ST. R/W ......... XT.
[3 YES
Plan Check No.__
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PIL 11-1107
13 YES
APPLICATION APPROVAL
ThiE application is not a perfait until
signed by the Building Official or Ids Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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