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RESIDENTIAL
BUILDING DEPARTMENT
Appueant FILL
USE
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740388
PERMIT APPLICATION
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NAME (OR NAME OF BUSINESS)
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LOT COVERAOF. / LOT COVAAOE
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PEItMItlB1BLE HEIOIIT 1 PROPOSED HEIGHT
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I TELEPRONF NUMBER
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EXISTING STREET R/W ............br/ DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ............FT.
REMARKS
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w'ES ❑ NO
DS. LOCAL SALES
Valuation Fee
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RESIDENTIAL
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NON-RESIDENTIAL
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BEAT A GAS LINE
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REPAIR
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IN MOVE
ElPOOL
WI I
IUafBER OF BTORIEd
NUMBER OF
SIGN
DWELLING
RETAINING WALL
UNITS
EXISTING STREET R/W ............br/ DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W ............FT. ............FT.
REMARKS
0 YES all
w'ES ❑ NO
DS. LOCAL SALES
Valuation Fee
5o�Z44 oE c� i
I'Ian Check Na .....................
1
FBUILDING
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4 PROPOSED USE
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PLOTPLAN (Indicate Building setbacks, abutting streets)
BEAT A GAS LINE
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have road this appllc¢llon; that the In-
formation given 1s correct; and that I am the owner, or the duly author-
ized agent or the owner. I agree to comply with city and state laws "T".
ATTENTION
APPLICATION APPROVAL
laling construction; and In doing the work authorized thereby, no person
x•111 be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application 1s not a permit until
i -
relating to Workmen's Compensation Insurance,
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY T
WORK NOTED
uty; and fees are paid, and receipt Is ae-
ehall be completed in ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged in space provided.
pleted in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
Dr•S BION TURE
n
DEPARTMENT
�O' —1
46
CITY OF
J
1
EDMONDS
ATE
NOTE: Applicant Subject to Plan Cheek Fee
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775-2525
Thle Permit r cork to be done on private property ONLY.
Any ennelruel lout nn the Puhlle Jmm�ln (e¢rbn, nldex'nikn, drh'ewBrn,
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rim•e r, rl r.,rill r,ilnlr,• �epnrnt' I'�'r�nlrnlnn.