740625.pdfPERMITNUMBER 740625
AME
REBIDENTIAL
❑
BUILDING DEPARTMENT
PERMIT APPLICATION
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Ineldo Heavy Lines
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ADDR
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NAME (OR E OF HUBINEBB)
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LINE
PERM
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LEGAL LOT VARIANCE OR CONDITIONAL
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PERMITNUMBER 740625
AME
REBIDENTIAL
❑
BUILDING DEPARTMENT
PERMIT APPLICATION
I AppllcnntFill
Ineldo Heavy Lines
°NE
ADDR
AD
NAME (OR E OF HUBINEBB)
�-
LINE
PERM
LOT
m MAILING DDRESS
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YERTI
C CI Y TELEP ONE NUMBER
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ACi•U.
LEGAL LOT VARIANCE OR CONDITIONAL
PERMITNUMBER 740625
AME
REBIDENTIAL
❑
FRONT BIDE REAR FRONT
SIDE REAR
❑ NEW
LINE
PLAN CHECKED BY
❑
NON-REBIDENTIAL
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1
LEGAL LOT VARIANCE OR CONDITIONAL
USE
ADDRESS
F
DEMOLISH
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YES NO PERMIT NUMBER
REMARK'
ALTER
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FEN C
PLANNING DEPT. APPROVAL
DATE:
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ORFILL
C CITY
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USE
TELEPHONE NUMBER
IN MOVE
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STREET R/\V
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NUMBER OF
PLOT PLAN (Indicate Building setback., abutting streets)
HEAT A GAB LINE
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THIS PROPERTY
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NAME
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REMARKS
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CELEPHNE NUMBER
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REBIDENTIAL
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LINE
PLAN CHECKED BY
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NON-REBIDENTIAL
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SIGN
ADD
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DEMOLISH
❑
WALL NINC
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FEN C
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ORFILL
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USE
REPAIR
IN MOVE
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(UMBER Oe' BTORIE9
NUMBER OF
PLOT PLAN (Indicate Building setback., abutting streets)
HEAT A GAB LINE
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DWELLING
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UN1T8
FENCE
YES [] NO
THIS SITE
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Valuation I Fee
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BUILDING
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4 PROPOSED
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USE
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PLOT PLAN (Indicate Building setback., abutting streets)
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SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
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formed.. given Is correct; and that I am the owner, or the duly author-
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Ized'Rent of the owner. I agree to comply with city and stale Iowa rage-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, an Deraon
will be employed In violation of the Labor Cade of the Slate 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 -
0j" P mit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
tty; and fees are paid, and receipt is ac-
ehall 'cons tea In ninety days; MOVED -IN BUILDINGS shall be com-
plc dI.'
n els nth'.)
ifnowledged In apace provided.
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el NA URB (OWNER OR AGENT) DATE iGN
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INSPECTION
D CTO830NA1, RE/�•
F' R' �``,
DEPARTMENT
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CITY OF
EDMONDS
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NOTE: Applicant Subject to Plan Check Fee
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775-2525
This Permit euvero cork to be done on private property ONLY.
Any rnn.l nirlinn nn the pnirllc demaln (rnrba, .IdewNlta, driveways, :rrun'•.1ubll rd.m.r xri�nrahr P•rml•elnn•
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