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TOTAL AMOUNT DUE
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BUILDING DEPARTMENT AppllpAyltFlll
PERMIT
ONE NUMBERI,.%U I USF
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ATTENTION
PERMIT APPLICATION Inside Ifeavy Linos
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will be employed In violation of the Labor Code of the Slate of Washington
TIHS PERMIT
ADDRESS
relating to Workmen's Compensation Insuranoc
AUTHORIZES
Signed by the Building Official Or his Dep -
NA SL (OR NAME OF BUSINESS)
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ONLY THE
µ•OTU{ NOTED
uty, and fees are paid, and receipt is Be
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EDMONDS
NOTE: Applicant Subject to Plan Check Fees.
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CITY
TELEPHONE NUMBER
ACTUAL OT TOTAL BLDG. AREA
Any construction on the public domain (curbs, sidewalks, dr
Any
marquees, Ste.) will require rrparele permleeton.
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REQUIRED YAItUtl OPOBF.0 YARDS
NAME
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TELEPHONE NUMDEit
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STATE LICENSE NUMBER
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
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PLAN CHECKED Y THIS SITE IS LOCATED IN THE CITY
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NUMBER OF TORIES NUMBER OF
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NATURE OF WORK TO BE DONE
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PROPOSED USE
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PLOT PLAN (Indicate SWIMng setbacks, abutting streets)
HEAT A OAS LINE
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have rend t61e application; that the In.
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format Ion given le correct; and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
TIHS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insuranoc
AUTHORIZES
Signed by the Building Official Or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
µ•OTU{ NOTED
uty, and fees are paid, and receipt is Be
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn-
knowledged in space provided.
pitted In six months.)
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31GNATURE (OWNER Olt AGENT) DATE BIGNED
INSPECTION
1 E R'9 IGNAIURE
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DEPARTMENT
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CITY OF,
TDAYS;
7
EDMONDS
NOTE: Applicant Subject to Plan Check Fees.
775-2525
This 1'1rm11, cur<n work to be done an private pnpeety ONLY.
Any construction on the public domain (curbs, sidewalks, dr
Any
marquees, Ste.) will require rrparele permleeton.
FILE
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RESIDENTIAL
SPECIAL INSPECTOR/REQUIRED
YES O.NO
A.'.
NEW
❑ NON-RESIDENTIAL
❑
IGN
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ADD
❑ DEMOLISH
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RETAINING
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BUILDING DEPARTMENT Applicant Fill
USE PERMIT
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PRE'INSPFIOVE
PLOT PLAN (Indicate Building Setbacks, abutting streets)
PERMIT APPLICATION
Insido Heavy Linos
ADDRESS
NUMBER OF STORIES NUMBER OF
FENCE
NAME OF IIUBINEBB)-��'
DWELL[NG
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tRETAINING
WALL
NAME (OR
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PERMld BtDL e/s ACTUAL JJ 0
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MAILING ADD ESS
SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
CITY
TELEPHONE NUMBER
ACTUAL BLDG. A;
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5 / (/. / A�hly
REQUIRED YARDS PORED YARDtl
TOTAL AMOUNT DUE
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Ihereby acknowledge that I hnvo rend this application; that Ota In-
FRONT HIDE REAR FRONT BIDE REAR
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formation given le correct; and that I am the owner, or the duly author.
NAME
ized agent of the owner. I agree to comply with city and state law, regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no yerean
LEi AL OT VARIANCE OR CO ITIONAL USE
will be employed In violation or the Labor Cade of the Biala of Washington
THIS PERMIT
This application is not a permit until
N
ADDRESS
Signed by the Building Official or his Dep -
BYES ❑ NO PERMIT NUMBER
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
utyi and fees are paid, and receipt is ac -
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
WORK NOTED
knowledged In space provided.
PLANNING D PT. PYROYAL _ DA F
plated In six month,.)
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C1TY TELEPHONE NUMBER
INSPECTION
DEPARTMENT
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STRE%�!
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EXIS IL/\V
EXISTING BTR}:ET R/.... irT. DEFICIENCY THIS PROPERTY
II'i i`i:•!(,�i *� %
CITY OF
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NAME
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COMP. PLAIT BT. R ♦K�.�.
NOTE: Applicant Subject to Plan Check Fee
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REMARKS ;I..,7. VC4)3y i.OPC)S 17Pt r0 exceed Blore
Any construction on the public domain (curbs, Sidewalks, driveways,
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ADDRESS
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i.n?:).cated (in Standard D3)r. bio. 103 N
TELEPHONE NUMBER
I F T. k cis ss pt✓tl_ CH CKED� Y
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METER_dl'LE SERVICE SIZE CLEARANCE CH •C ED Y
STATE LICENSE NUMBER CITY LICENSE NUMBER �. I // I
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REMARKS
Legal Description 11 Property (Show Bclaw or Attach Four Culls)
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TYP,E'COICNECTION VERIFIED BY
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RESIDENTIAL
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YES O.NO
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❑ NON-RESIDENTIAL
❑
IGN
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❑ DEMOLISH
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RETAINING
WALL
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❑ OORLI
❑ REPAIR
PRE'INSPFIOVE
PLOT PLAN (Indicate Building Setbacks, abutting streets)
❑
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POOL
NUMBER OF STORIES NUMBER OF
FENCE
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DWELL[NG
SIGN
tRETAINING
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NATURE OF WORK
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flan Check No .....................
SPECIAL INSPECTOR/REQUIRED
YES O.NO
OCCUPANCY GROUP
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PLAN CHECKEDpY
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THIS SITE IS LOCATED IN THE CITY
OF EDMON DS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REafARK9
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BUILDING
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4 PROPOSED USE
Valuation
Fee
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flan Check No .....................
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PLOT PLAN (Indicate Building Setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
SIGN
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WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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L`..�
Ihereby acknowledge that I hnvo rend this application; that Ota In-
c
formation given le correct; and that I am the owner, or the duly author.
ized agent of the owner. I agree to comply with city and state law, regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no yerean
will be employed In violation or the Labor Cade of the Biala 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 THE
utyi and fees are paid, and receipt is ac -
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com.
WORK NOTED
knowledged In space provided.
plated In six month,.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
XHAECTORIS SIGNATURE
II'i i`i:•!(,�i *� %
CITY OF
Fes' //I/�../
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
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This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, Sidewalks, driveways,
INSPECTOR
marquees, etc.) will require separate permission.
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