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❑ ADD
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SPECIAL INSPECTOR AREA
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❑ ALTEREXCAVATE
FENCE
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t Hereby acknowledge
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that I It v. read this applIcaaan; that the In-
(armatlon given is a+.Ct;
and (hot I vn the owner, or the duly author-
Ired agent of the owner.
lating canetrucllon; Ind
I agree to comply with city end elatelaws re -
In doing the work authorized thatch), no Denon
ATTENTION
APPLICATION APPROVAL
will be employed In vlalellon
of the Labor Code of the Stale of Waehlogton
THIS PERMIT
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relating to Workmen'
Compensation Insurance.
This application is not a permit until
NOTE: Permit Limit
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One Year (E.Cept DEMOLITIONS which
AUTHORIZES
ONLY THE
elgned by the Building Official or his Dep -
.hall be Completed In
ninety days; 5IOVED-IN BU ILDINGH .lull be corn-
WORK NOTED
uty; and fees are paid, and receipt is ac-
plCtCd In .1. months.)
knowledged in space provided.
SIG A WNER
OR AG/E/j'T )�
❑ATE ICN
INSPECTION
DEPARTMENT
OI ECT R 5 GNAT RE
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CITY OF
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NOT -. Alplicant
NO
Subject fu Plnn Check Fee
775-2525
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This Permit cover
work to be done on private property ONLY.
Any ano
the public domain (curbs, sidewalks, driveways,
ORIGINAL - f da YEL OW - Inspccler
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marquees
etc.( will require sepereto permission.
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BUILDING DEPARTMENT Applicant Fill
PERMIT
ZONE NUMBER
PERMIT APPLICATION Inside Has., Lines
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NAME (OR NAME OF,BV9IN
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LOT AREA
SUBDIVISION NO.
FIRE ZONETYPE
OF CONSTRUCTION
CODE
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TELEPHONE NUMBER
PLANNING pEPT. APPROVAL DATE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
HEAT & GAS LINE
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Legal Description of, Property (Show Below
or Attach Four Copies)
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WORK REQ'D \ �' ❑�N�O/ I l,l
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UNDERGROUND d1.,YES
REQ'D ❑ NO'V
WIRING
TOTAL AMOUNT DUE
OVERT
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I hereby acknowledge that I have read this application: that the In-
1EO;'BY /
TYPE CONNECTION J /
tormaitan given Ie correct; and that I e e the owner, or the duly authmr
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Iced agent or the owner. I agree to comply with city and stale laws "go.
thereby, no
ATTENTION
APPLICATION APPROVAL
latlnif conetructlon; rend In doing the Work authorised parson
Will be employed In violation of the Labor Code or the State of Washington
L] YES PERMIT NUM BER
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AUTHORIZES
SEPTIC SYSTEM
APPVO BY CITY ENG. ❑ NO
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REMARKS
utyi and tees are paid, and receipt is ac-
IN08 shall be cam-
ehnll be completed In nicety days; MOVED -IN BUILDINGS
WORK NOTED
knowledged In apace provided.
plcled In elz months.)
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DEPARTMENT
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CODE
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WALL
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❑ YES ;❑ NO
BY
THIS SITE IS LOCATED IN THE CITY
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on FILL
PLAN CHECKED
OF EDMONDS. LOCAL SALES TAX
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❑ REPAIR PRE -MOVE SWIM
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MaER.00RIES
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UNITS
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NATO OF WORK TO BEL DONE
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VALUATION FEE
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BUILDING
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in
HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application: that the In-
tormaitan given Ie correct; and that I e e the owner, or the duly authmr
Iced agent or the owner. I agree to comply with city and stale laws "go.
thereby, no
ATTENTION
APPLICATION APPROVAL
latlnif conetructlon; rend In doing the Work authorised parson
Will be employed In violation of the Labor Code or the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compsnratlon Iosurartu.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except TIONa welch
ONLY HE
utyi and tees are paid, and receipt is ac-
IN08 shall be cam-
ehnll be completed In nicety days; MOVED -IN BUILDINGS
WORK NOTED
knowledged In apace provided.
plcled In elz months.)
INSPECTION
SIGNATURE (OWNER OR AGENT) GATE 51GNE0
DEPARTMENT
DIRECTOR'S SIGNATURE
CITY OF
r
EDMONDS1
DATE -
NOTE-: Applicant SNGicct tO Plan Oleck Fee
775-2525
3
This Permit covers work to be done an private property ONLY.
Any on the public domain (curbs, sidewalks, driveways,
ORIGINAL -File YELLOW • Ing t'p'ctor
construction
marquees, etc.) will require separate permission.
PINK - Owner GOLD - Asses%cr
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ALL SITUATE 11\1 THE COUNTY OF SNOF10141ISH, STATE OF WASHINGTON. (l