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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside 11cavy Lines
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E3�RESIDENTIAL
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1:1 NON-RESIDENTIAL
SIGN
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ElDEMOLISH
RETAINING
WALL
ALTER
EXCAVATE
M OR FILL
FENCE
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REPAIR
PRE -MOVE
11 INSP.
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swim
POOL
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
vnwri-ln ON KROLL MAP NO.:
PERMIT
NUMBER - 1 7 00082
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'ARD SETBACK STREET SETBACK ROAR YARD SETBAUX
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ONE LOT AREA VACANT SITE
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ILDING AREA I VARIANCE NUMBER 0.
EXISTING I STREET R/W ............ rT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ FT. 0
REMARKS
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TYPE OFF_CQkV5'TRUCTION STREET IMPROVED
CJ YES
SPECIAL INSPECTOR REQUIRED
[] YES UKO
OCCUPANCY GROUP
PLAN CHECKED
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Plan Check No .........
Receipt No.
BUILDING
PLUBMISIG
HEAT & GAS IANE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
6'6':*4 4;
T
TOTAL AMOUNT DUE
TOTA L A 0 U N
t the
I hereby acknowledge that I have read this application; that the In-
APPLICA71ON APPROVAL
This application Is not a permit until
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formation given Is correct; and that I am the owner, or the duty author-
'y
law 8 gu
Ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
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no pordo
lating construction; and In doing the work authorized thereby. no person
Washington T If 7
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will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS jwhich
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
AUTHORIZES
AUMOIUZI
r Tm
ONLY THE
WORK NOTED
signed by the Building Official or his Dep-
uty; and fees are paid, find receipt is ac-
knowledged in space provided.
pleted In mix months.) . 3; 1)
lIGNATURE (OWNER OR AGENT) SIGNED
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NOTE: Applicant Subject to Plan Check Fee
INSPECTION
2
DEPARTMENT
Cj�y 01
CITY OF
EDMONDS
PH 6.1107
DIRECTOR'S SIGNATU
DATE
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Thin Permit covers vrork to be done on private property ONLY.
Any construction on the public donagn (curb@, sidewalks, driveways,
marquees, ate.) win require separate permission.