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formation given Is correct; and that I am the owner, or the duly author-
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ATTENTION
APPLICATION APPROVAL -
iating construction; and In doing the work authorized thereby, no person
REMARKS
will be employed In violation of the Labor Code of the Slate of Washington
Legal Description of Property (Show Below or Attach Four Copies)
This application is not a permit until
relating to Workmen'. Compensation Imura ee.
AUTIIOR1IZE8
signed by the Building Official or his Dep -
TYPE CONNECTION VERIFIED BY
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shall be completed In ninety any.; MOVED -IN BUILDINGS Shall be cam•
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SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTIONR
TOR'S BIO U -
DEPARTMENT
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REMARKS
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Any construction on the public domain (Curb&, eidewalke, driveways.
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marquee., etc.) will require separate permisslon.
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SPECIAL INSPECTOR/RE941UUIIIREDO/CCUPANCY GROUP
YES 02fD
EBIDENTIAL GAfi
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PLA CKED IIY IS LOCATED IN THE CITY
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LOCAL TAX
NON-RESIDENTIAL 9ION
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EXCAVATION OR FILL
TOTAL AMOUNT
I hereby acknowledge that I 6nve 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 stele laws regu-
ATTENTION
APPLICATION APPROVAL -
iating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Imura ee.
AUTIIOR1IZE8
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
NOTE:
ONLY THE
WORK NOTED
and fees are paid, and receipt is ac -
shall be completed In ninety any.; MOVED -IN BUILDINGS Shall be cam•
knowledged in space provided.
pleted in six month..)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTIONR
TOR'S BIO U -
DEPARTMENT
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CITY OF
ED11fON1_3S
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NOTE: Applicant Subject to Plan Check Fre
775-2525^
This Permit co work W be done on prh'ote property ONLY.
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marquee., etc.) will require separate permisslon.
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONE
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DEMOLITION
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EXCAVATION OR FILL
I hereby acknowledge that I have rend title applleatlon: that Uta In-
TOTAL AMOUNT DUE
lormatna given iscorrect; and that I nm the owner, or the duty author-
Ized agent at tho owner. I agree to comply with city and state law, re
ATTENTION
APPLICATION APPROVAL
toting coaetruction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wmhloglon
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
-
Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
and fees are old, and receipt is ac -
utY P p
,hall be completed In ninety days; MOVED -IN BUILDINGS ,hall be cam-
shall
knowledged in apace provided.
plelcd In els month..)
SIGNATURE tOWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENTtA
R CTOR'S SIGNATURES r,
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CITY OF
EDMONDS
NOTE: Applicarit Subject to Plan Check Fee
775-2828
This Ile mit c-crn work to be dans on private propert ONLY.
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Any constructluninn an tits public domain (curb,, .I-0.1,, driveway,,
INSPECTOR/
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ntntauees, etc.) x'111 Myulre .epnr,te permlrelon,
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