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PERMIT APPLICATION
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ADDRESS /��
NAME (OR NAME OF BUSINESS)
/ PE)t�3s � i .a � ACT AL
LOT COVAAO I ..O
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S�O LOT COVERAGE �i� IL/
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Plan Check No .....................
LEGAL LOT VAHIANCE OR ONDITIONAL SE
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ml YEB 0 NO PERMIT NUMBER
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NEW
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FENCE
IN6 DEPT APPAO A
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TELEPHONE NUMBER
STREET R/W
EXISTING ST T R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............FT.
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NAME
REMARKS
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EXCAVATION OR FILL
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NON-REBIDENTIAL
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HOULD eE CODED 31.04.
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TELEPHONE NUMBER
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BEAVICE SIZE
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CITY LICENSE NUMBER
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REMARKS
APPLICATION APPROVAL
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Legal Description of Property (Show Below or Attach Four Copies)
REPAIa
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TYPE CONNECTION
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DWELLING
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REMARKS
pleted In six months.)
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I I n YESR No
I R' SIGNATU
Y PROPOSED UeE
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aPLOT PLAN (Indicate Bi
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Plan Check No .....................
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RESIDENTIAL
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LINE
❑ YES ),] NO I 1
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NEW
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FENCE
SIGN
PLAN CHEC
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THIS SITE IS LOCATED IN THE CITY
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OF EDMONDS. LOCAL SALES TAX
EXCAVATION OR FILL
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HOULD eE CODED 31.04.
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formation given Is correct; and that 1 am the owner, or the duly author-
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OR FILL
APPLICATION APPROVAL
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Ialing construction; and In doing the work authorized therohy, no person
REPAIa
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N Ps10YE
INSP.
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SWIM
POOL
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fUAIBER OF eTOR1E9
NUMBER OF
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NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
DWELLING
UNITS
ImoWledged In space provided.
pleted In six months.)
Y PROPOSED UeE
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aPLOT PLAN (Indicate Bi
See f14n5
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Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this appllcallon; that the In-�—
formation given Is correct; and that 1 am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu.
ATTENTION
APPLICATION APPROVAL
Ialing construction; and In doing the work authorized therohy, no person
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will be employed In violation of the Labor Code of the State of Washington
TIDE PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance•
AUTHORIZER
Signed by the Building Official or his Dep-
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NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
ImoWledged In space provided.
pleted In six months.)
HGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
I R' SIGNATU
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CITY OF
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EDDIOND$
ATE
NOTE: Applicant Subject to Plan Check Fee
_ 3 _
775-2325
Title t'ennit coven work to be done on private property ONLY.
Any eenetrnetlon an Ilse Public domain (curbs, sidewalks, driveways'
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