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PLAN CHECKED BY THIS SITE 15 LOCATED IN THE CITY
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formation given le correct; and that I am the owner, or the duly author-
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E LOT VARIANCE ORNUMBERCOND IONAL USE
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totaling 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
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STREET R/W
shall be completed In ninety days; MOVED -IN BUILDINGS shalt be com-
knowledged In space provided.
pleted In six months.)
EXISTING STQET R/W ............FT.
DEFICIENCY THIS PROPERTY
HIGNATURE' (Ow ER OR AGENT) DATE SIGNED
INSPECTION
CTO 'e S TURE
NAME /
COMP.LAN ST. R/W ............FT.
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This Permit coven work to W done on private properly ONLY.
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Any construction on the public domain (cnrbs, slde•s dk., driveways,
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TELEPHONE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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NUMBER OF STORIES NUMBER OF
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PLAN CHECKED BY THIS SITE 15 LOCATED IN THE CITY
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I hereby acknowledge that I have read this application; that the 1n-
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formation given le correct; and that I am the owner, or the duly author-
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agent pf the owner. I agree to comply with city and elate law. gu-
ATTENTION
APPLICATION APPROVAL
lacing construction; and In doing the work authorized thereby, an person
will be employed In violation of the Labor Code of the State Of Washington
TIU8 PERMIT
This application Is not a permit untll
totaling 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 shalt be com-
knowledged In space provided.
pleted In six months.)
HIGNATURE' (Ow ER OR AGENT) DATE SIGNED
INSPECTION
CTO 'e S TURE
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DEPARTMENT
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CITY OF
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EDMONDS
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NOTE: Applicant Subject to Flan Check Fee
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This Permit coven work to W done on private properly ONLY.
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