700519.pdfBUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION
NAME
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WA-1—UNG ADDRESS
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CITY LEPHONE
;2.211J-760
NAME
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CITY TELEPHONE NUM
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STATE LICENSE NUMBER CITY LICENSE NUAlff
�2�2.3-401_ 73�'56
Legal Description of Property (Show Below or Attach Four Copies)
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DWELLING
UNITS
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NUMBER 700519
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DE YARD SETBACK LiTIMIN, SETBACK RmAlt YARD BETBAUJ
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EXISTING STREET R/W .��FT. DEFICIENCY THIS PROPERTY
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SPECIAL INSPECTOR REQUIRED OCCUPANCY ORO
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PLAN CHECKED BYV
REMAINS—
Plan Check No .....................
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EXC VATION
EXCAVATION OR FILL
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-
lzed agent of the owner. I airrea 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 Coda of the Slats of Washington
relating to Workmen-9 Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be eom-
pleted In six months.)
11111MAWTUR In1VW7.R Oa KOEN2r)v I DATE SIGNED
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NOTE: Applicant Subject to Plan Check Fee
This Femit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks# driveways,
nuLrquees, etc.) will require separate PermiNalm.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
Valuation I Fee
41
00
No.
APPLICATION APPROVAL
This application Is not a permit until
slirned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged In space provided.
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RECORD OF INSPECTIONS
Date Passed
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