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LEGAL LOT VARIANCE OR CONDITIONAL USE
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ATTENTION
APPLICATION APPROVAL
tall.. construction; and In doing the work authorized thereby, no person
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0 YES 0 NO PERMIT NUMBER
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
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PLANNING DEPT. APPROVAL DATE:
AUTHORIZES
signed by the Building Official or his Dep -
CITY
TELEPHONE NUMBER
ONLY TILE
uty; and fees are paid, and receipt Is ac -
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shall be completed In ninety days: MOVED -IN BUILDINGS ,hall be com-
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knowledged in space provided.
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STATE LICENSE NUMdBER
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REMARKS
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1 hereby fleknowletlgo that I have reed this application; that the In-
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formation given Is correct; and that I am the owner, or the duly author.
,
Iced agent oI tho owner. I agree to comply with city and elate low, rsgu-
ATTENTION
APPLICATION APPROVAL
tall.. construction; and In doing the work authorized thereby, no person
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 Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
uty; and fees are paid, and receipt Is ac -
shall be completed In ninety days: MOVED -IN BUILDINGS ,hall be com-
WORE NOTED
knowledged in space provided.
Fisted In slz ..nth..),)AGE
BIG A UI(E NV OR AGE T)
DATE SIGNED
INSPECTION
DEPARTMENT
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NOTE: Applicant Subject to Plan Check Fee
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TW. Permit cnvrrs work to be done on private property ONLY.
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PERMIT APPLICATION Ineldo HrRYy Lines
NAME (OR NAME OF BUSINESS)
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BUILDING
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PROPOSED USE
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PLOT PLAN (Indicate Building eetb C pbnt"n6 Blrcete)
HEAT h GAB LINE
FENCE
1 �
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
- !.
TOTAL AMOUNT DUE
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.
Ized agent of the owner. I agree to comply with city and state laws "I;u-
ATTENTION
APPLICATION
t
,.ting construction; and la dolbg the work authorized thereby, no person
APPROVAL
Will beemployed In violation of the Labor Code of the State of Washington
TIAs PERMIT
This application is not a permit until
III ating to Workmen's Compensation Insurance.
AUTHORIZER
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except IIF.\IOI.ITIONA which
ONLY TIDE
WORK NOTED
uty; and fees are paid, and receipt is ac-
ehall be completed In ninety days; MOVED -IN BUILDINGS Shall be cam.
knowledged In space provided.
pleted In el% months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
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I
DEPARTMENT
CITY OF
-
EDhIOND3
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This PTnit conrrs work le be done an private properly ONLY.
Any construction on Itis public domain (curbs, sidewalks, driveways,
marquees, etc.) will require sePa ste pennlsNon.
" , INSPECTOR
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