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BUILDING DEPART M E N T
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PERMIT APPLICATION
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DEMOLISH WAIT'
REMARKS
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I hereby acknowledge that I have read this application; that the In-
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formatlon given 1s correct; and that I am the owner, or the duly author-
ized agent of the owner. 1 agree to comply with city and elate Inwe regu-
ATTENTION
APPLICATION APPROVAL
lating co and In tlolag the work authorized thereby, no person
will be employed In violation o[ Ne Labor Code of the State o[ Washington
THIS PERMIT
This application is not a permit until
r...uag to Workmen's Compensation Iasuraau.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty: and fees are paid, and receipt is ae-
ehall be completed In ninety day.; MOVED -IN BUILDINGS ehali he corn.
knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
DIRECTOR' BIG
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DEPARTMENT
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CITY OF
EDl}IONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This 1•erutlt cuvrn work to be Bane on private property ONLY.
Any <easlrucllon on it,. public dnm.ln (curb., sidewalk., drlyew.,Y.,
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neaque— eta.) will require separate perml..lan.
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RESIDENTIAL ❑ LINE
PLAN CHECKED flY THIS SITE IS LOCATED IN THE CITY
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OF EDMONDS. LOCAL SALES TAX
NON-RESIDENTIAL E]gION
SHOULD BE CODED 31.04.
F] ADD DEMOLISH RETAINING
REMARKS
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ALL LJQ PC FeVL UFC 3
ALTER [:]OR FILL AVATE [:] PENCE
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REPAIR ❑ INSP. POOL
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NUMBER OF STORIES
NUMIBER OF
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DWELLING
UNITS 6,% L'
NATURE OF WORK TO HE DONE
Valuation
Fce Receipt No.
Via. Check N. .....................
BUILDING
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PROPOSED USE
PLUMBING
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aPLOT
PLAN (Indicate Building setback., abutting streets)
HEAT A GAS LINE
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FENCE
SIGN
RETAINING WALL
-
N
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMIOUNT DUE
•) 1. /�
I hereby acknowledge that 1 have rend this application; that the In-
form.tlan given le correct; and that I the owner, or the duly aulhor-
leld agent of the owner. I agree to comply with city and elate Lowe rtgu-
ATTENTION APPLICATION APPROVAL
Iating construction; and in doing the work authorlxed thereby, no person
will be employed In vlolatlen of Lha 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 -
ONLY TILE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MCOVED-IN BUILDINGS shell be com- knowledged in space provided.
pitted In six months.)
SIGNATURE (OWNER OR AGENT) DATE 916NEU
INSPECTION DIRECTOR'SBfONf�A_TUR_E_ 1i"'
DEPARTMENT
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4�A.f
)� CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Cbeek Fee
775-2525
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Thle 1'etmlt covers work lu bo done on private property ONLY.
Any r ... t ucll.n en the public domain (curb., sidewalks, fti-may.,
INSPECTOR
marquees, etc.) will require separate pertnleelon.