680508.pdfBUILDING DEPARTMENT Applicant m
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PERMIT APPLICATION
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Inside Heavy Lines
NAME JOB NAME OF BUSINESS)
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MAILING ADDRESS
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CITY
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LEPHONE NUMBER
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NAME f
ADDRESS
CITY
TELEPH ONE NUMBER
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CITY
TELEPHONE NUMBER
Legal Description of Property (Show Below or A
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GAS
LINE
Vj"NEW
RrENTIAL
.-RESIDENTIAL
I(
F�
RETAINING
WALL
DEMOLISH
ALTER
EXCAVATE
OR FILL
FENCE
Ft.)
..........
El REPAIR
El
PRE -MOVE
INSP.
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
C
P No.: PERMIT
I NUMBER
13 YES
EXISTING -STREET R/W ........... FT. DEFICIENCY
COMP. PLAN ST. R/W ............ FT. .....
[I YES
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Plan Check No ....................
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BUILDING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
BEAT & GAS LINE
,30 4
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formaUon given to 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-
ATTENTICON
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
THIS PERMIT
relating to Workmen's Compennation. Insurance.
AUTHOR1[ZE8
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed in ninety days; MOVED-JIN BUILDINGS shall be com-
pleted In six months.)
IIGNATURE (OWNER OR AGENT)
SIGNED
INSPECTION
11141.11Z
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PH 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the Public dotnain (curbsi aldewalkBg drivewaysp
marqums, etc.) will require separate permission.
iUMBER
PROPERTY
I
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[:I YES 9-116-
Fee
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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