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REPAIR ❑ PRE-MOVE
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THIS SITE IS LOCATED IN THE CITY
OF EDMONDS.
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I hereby acknowledge that i hove read this aPPI[Catlon; that the In.
formation le
TOTAL AMOUNT DUE
given correct; and that I sin the owner, or the duly author-
Ized agent Of the owner. I agree to COMP1Y with city and state laws Mini.
titling construction; and In doing the work authorised thereby, no person
will be employed In vlolnllm of the Labor Code of the State of Washington
ATTENTION
APPLICATION APPROVAL
relating to Workmen's C—Peneatlon Insurance.
THIS PERMIT
AUTHORIZES
This application is not a permit until
NOTE: Permit Limit One Year (EXCePt DEMOLITIONS WhichONLY
THE
signed by the Building Official or his Dep-
shall be Completed In ninety days; MOVED-1N BUILDINGS shall be win.
WORK NOTED
uty; and fees are paid, and receipt is ac-
plm menthe.)
knowledged in space provided.
SIGNANA TURERE (OWNER O .ENT) DATE SIGNED
INSPECTION
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DEPARTMENT
CITY OF
DIRECTOR' SIG
ED MONDS
NOTE: Applicant Subject to Plait Oteck Fee
DATE
This Permit covers work to be done on private roperty ONLY.
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Any construction on the public domain (curbs,
77$-2$2$
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sidewalks, driveways,
marquees, etc.) will require separate permission.
ORIGINAL -file YELLOW - Inspector
PINK • Dinner GOLD- Av.oss,',
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USE PERMIT
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{ BUILDING DEPARTMENT Applicant Fin '� — 950439
PERMIT APPLICATION Inside Heavy Lines S �•t
ADDRESS
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NAME (OR NAME OF BUSINESS) --n
NAME
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YES NO
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VARIANCE OR �. ADIi-NOf _
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CITY ELEPHONE NVMBER 2
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FRONT �{•� ✓
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= REQUIREMENTS
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C CITY TELEPHONE NUMBER
PLANNING OPT. APPROVAL DATEi
NAME
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" EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
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- ADDRESS COMP. PLAN ST. R/W FT. FT.
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TELEPHONE NUMBER REMARKS t•J � % 2
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N` H ID TN !/ •�F--[ (i )-) .71-7/V ❑ YES PERMIT NUMBER W
SEPTIC SYSTEM
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REMARKS
❑ NEW El RESIDENTIAL El L NE FIRE ZONE- TYPE OF CONSTRUCTION CODE
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❑ NON.RESIDENTIAL SIGN / ICS"`- ��.1,'i�!'l
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ADD ❑ DEMOLISH ❑ A LINING I.CR EDU IREIONSPE CTOR REI% 1;'t GROUPANCY /r LOA pPANT
WALL
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❑ ALTER EXCAVATE FENCE ❑ YES ❑,NO
OR FILL ❑ (� X_FTI PLAN CHECKED BY THIS SITE IS LOCATED -IN THE CITY w
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,'1 - / OF EDMON DS, LOCAL SALES TAX
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INSP. POOL
REMARKS � �
NUMBER OF STORIES NUMBER OF r((
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+ 1A DWELLING
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NATURE OF WORK TO BE DONE
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VALUATION FEE
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PRO/POSED((USE//PLAN CHECK
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ABUTTING STREETS) BVILOING ��% 126,e
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FENCE
SIGN
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RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read this application; that the Ir- TOTAL AMOUNT DUE
farmallon given Ie e—eet; and that I am the owner, or the difly author•
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Ized agent o[ the owner. I agree to Comply with city and slat. lawn reg--
ATTENTION APPLICATION APPROVAL
Jaime conetra U U; and In doing the work authorlead thereby, no person
will be employed In violation or the Labor Cade or lh. Stale of WYh1.11ton THIS PERMIT
This application is not a permit until
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relating to Workmen'. Carepenl.tlon Irrurmce. AUTHORIZES
signed by the Building Official or his Dep -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which aid, and receipt 1H ac-
ntyi
and fees are PORK
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shall be completed in aloety days; MOVED -IN BUILDINGS shall be core- WNOTED
lt nowledged in space provided.,
Plated In six months.)
INSPECTION
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SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT DIRECTOR'S SIGV&T4 E _
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CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to P14111 C Teck Fee775-2525
;
This Permit covers work to be done on private pproperty ONLY.
domain (curbs, sidawalW, driveways, ORIGINAL - rile YELLOW InspcUor
Any construction on the public
marquees, etc.) will require separate permission. PINK - Ovrner GOLD - Assessor
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RECORD of INSF r :`'
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