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VPLUMBING
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DEPARTMENT Applicant FillZONE
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aPLOT
PERMIT
APPLICATION Inside Heavy Lines
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HEAT & GAS LINE
ADDRESS
NAME (OR NAME F BUBINE081
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TELEPHONE NUMBER
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NAME
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COMP. PLAN BT. R/ .LUn�. .f�...FT.
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REMARKS Driveway slopes not to excee 04e
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I hereat acknowledge that I have read t61e application; that the In-
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indicated on Standard Bwg. No. 103
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formation given Is correct; and that I am the owner• or the duly authmr
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ATTENTION
TELEPHONE NUMBERn
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lating construction; and In doing the work authorlxed thereby, no person
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will be employed In violation of the Labor Code of the Stale of Washington
UER
SIZE SERVICE SIZE CARANCE
MET((iddlt
relating to Workmen's Compensation Insurance.
STATE—LICENSE NUMBERI
CITY LICENSE NUMBER
ice----`--- J
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIF.
WORK NOTED
uty; and fees are paid, and receipt is so -
shall bo ced In Well, days; MOVED -IN BUILDIN II be coon-
ImoWledged in space provided.
Dieted e1 at.)
REMARKS
Legal Description of Properly (Show Below or Attach Four copies)
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SIG AT to OR ENT) DATE SIGNED
INSPECTION
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PERM(T)NUMBER
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REMARKS
775-2525
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Title Prrmltc rete walk to be d private property ONLY.
FIRE ZONE TYPE OF CONSTRUCTION eTREET�dMPROVED
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B NO
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EFPEMIAL INSPECTORR IRED OCCUPANCY GROUP
RESIDENTIAL ❑ G
LINE
❑ YES j�190
NEW
PLAN CHEC D Y THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL SIGN
EDMONDS. LOCAL SALES TAX
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ADD
RETAINING
1H
R HOULD BE CODED 31.04.
0 DEMOLISH WALL
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EXCAVATE FENCE
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El REPAIR
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INSP. El
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
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No.
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NATURE OF(WORK TO HE DONE
Valuation
Fee
Receipt
Pian cheek No .....................
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PROPOSED USE
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RETAINING WALL
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SWIMMING POOL
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereat acknowledge that I have read t61e application; that the In-
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formation given Is correct; and that I am the owner• or the duly authmr
ized agent of the owner. I agree to comply with city and stale lawregu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorlxed thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
ice----`--- J
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIF.
WORK NOTED
uty; and fees are paid, and receipt is so -
shall bo ced In Well, days; MOVED -IN BUILDIN II be coon-
ImoWledged in space provided.
Dieted e1 at.)
SIG AT to OR ENT) DATE SIGNED
INSPECTION
3R R' S3ON TU
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DEPARTMENT
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EDIIIONDB
ATE il
NOTE: Applicant SvGjec to do Check Fee
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775-2525
Title Prrmltc rete walk to be d private property ONLY.
Any rnnH nlrtinn nn the pnbllc dnmaln Icurbe, nidew'nikn� Irl—Y.,
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PERSONALIZED CUSTOM BUILDING
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82.1 TALBOT
ROAD
EDMONDS. WASHINGTON.
98020,
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