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PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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CITY TELEPHONE NUMBER
NAME
ADDRESS
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PROPOSED ARDS
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FIRE ZONE TYPE OF CONST ION ETRE T IMPROVED
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TELEPHONE NUMB
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STATE LICENSE NUMBER
CITY LICENSE NUMBER .S
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NUMBER OF STORIES NUMBER OF
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Valuation Fee Receipt No.
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SPECIAL INSPECTOR REQUIREDOCCUPANCY GROUP
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NON-RESIDENTIAL SIGN
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DEMOLISH ❑ R ply SNC
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NUMBER OF STORIES NUMBER OF
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Valuation Fee Receipt No.
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BUILDING
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PLUMBING
PLOT PLAN (Indicate Building eetbaeks, abutting street.)
HEAT & GAS LINE if G
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have rend this application; that the
TOTAL Ag(OONT DUE
In.
formation given Is correct; and that I am the owner, or the duly author.
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Izedlata agent tr the owner. I agree to comply with city and erste Inwe ergo-
Iating construction; and to doing the work authorizad thereby, no Dereon
ATTENTION APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT This application is not a permit until
relating to Workmen's Compeneatton Insurance.
AUTHORIZES Signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY NOT ut and fees are aid, and receipt is ac-
WORKNOTED p
_
shallbe completed In ninety days; MOVED -IN BUILDINGS shall be com.
11nowledged lit apacce provided.
pieced In .Ix month..)
NIG—NAM (OWNER OR AGE -7,S; DATE EU
INSPECTION R'8 URE
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DEPARTMENT
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CITY OF
EDMONDS DATE
NOTE: Applicant $Ithject to Plan Check Fee
_ 2
775-2525
This 1'ernlit curers work Ice Do donoon prIv.te property ONLY*
Any rOnetruetlnn on the publle drmn lenrbs, sidewalk., drlveway.,
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i., rne,•rr, ,etc., �, nl re.inlrr Irr,ulsnlOn. _
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