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PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
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BUILDING AREA VARIANCE NUMBER
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STREET B/W 1
EXISTING STREET R/W ... FT, DEFICIENCY THIS PROPERTY j
, ITELEPHONE NUMBER "
' . COMP. PLAN BT. R/W ............FT. ............PT. t7 '
Legal Description Or Property (Snow ismow or Attach nuur copies;
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RESIDENTIAL ❑ LLIN NE
Y ' l NEW
+ E NON-RESIDENTIAL SIGN
ADD RETAINING
WALL
DEMOLISH
ALTER EXCAVATE FENCE
a OR FILL .......
REPAIR ❑ PRE -MOVE SWIM
INSP. POOL
NUMBER OF BTORiEB NUMBER OF
' DWELLING ! I UNITS j
I hereby acknowledge that I have read thin application; that the In-
formation given Is correct; and that I am the owner, or the duly author-
ised agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the state of Washington
relating to Workmeh's Compensation Insurance,
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) f%
NOTE: Applicant Subject to Plan Check Fee
This Permit coven
work to
be done on private property ONLY.
Any construction an
the public
domain (curbs,
sidewalks, driveways,
nsaequees,
etc,) wW
require separate
permission,
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CHECKED BY �....
CLEARANCE (CHECKED BY
i
VERIFIED BY
PERMIT NUMBER
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VSTRUCTION STREET IMPROVED
❑ YES ❑ NO
8ED (OCCUPANCY GROUP
THIS SITE —, IS LOGATED IN THE REMARKS CITY OF EDMONDS. LOCAL SALES Il
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❑ NO
Plan Check No* ............ ....
1:1WA Rre
4#iW 4Ur
PENCE
SIGN
RETAINING WALL
all JJT �ii: * • • r
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
CITY OF
EDMONDS
PR 6-1107
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