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STATE LICENSE NUMBER
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relatlog to Workmen's Compensation Insurance.
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Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY EJYES
IGNq TORE (OWNER OR AGENT) GATE SIGNED
WORK REQ'D ❑ NO
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TYPE OF_.CO�N. STRlt1CTION CODE
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❑ ADD ❑ DEMOLISH ❑ RETAINING
SPECIALINSPECTOR
REOVIRED
AREA
OCCUPANCY OCCUPANT
GROUP LOAD
❑ WALL
ALTER EXCAVATE ❑FENCE
OR FILL 1_ x_Fr)
❑ YES ❑ NO
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❑ REPAIRPRE-MOVE SWIM
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PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. CAL SALES TAX
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INSP. POOL
REMARKS
NUMBER OF STORIESNUMBER
OF
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UNITS
NATURE OF WORK TO BE DONE/(�
PROPOSED USE
VALUATION FEE
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NO.
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ABUTTING STREETS)
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PLUMBING
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FENCE
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SIGN
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RETAINING WALL
SWIMMING POOL
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TOTAL AMOUNT DUE
I hereby eckaowledge that I have read this application; that the In-
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formation glven Is correct; and that I am the owner, or the duly aur-
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(Zed agent of the owner. I agree to comply with city and stale law. regu-
lating con.tmctlon; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
Will be employed In violation of the Labor Code of the elate of Washington
THIS PERMIT
relatlog to Workmen's Compensation Insurance.
This application is not a permit until
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NOTE: Permit Limit One Your (Eicept DEMOLITIONS which
AUTHORIZE
ONLY THES
signed by the Building Official or his Dep •
_
shall be completed In ninety day.; MOVED -IN BUILDINGS shall be com.
WORK NOTED
uty; and fees are paid, and receipt is ac-
pleted W sig months.)
knowledged in space provided.
IGNq TORE (OWNER OR AGENT) GATE SIGNED
INSPECTION
DEPARTMENT
DIRECTO GNA U
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CITY OF
EDMON-
DATE
NOTE: A lit Subject to Plan C!(eck Fee
775-2525
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This Permit covers to be done on ONLY.
work private property
Any construction on the public domain Ieurbs, sidewalks, driveways,
ORIGINAL -File YELLOW - Impecter
marquees, etc.) will require separate permission.
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