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PLAN CRECHEDY THIS SITE IS LOCATED IN THE CITY
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BUILDING DEPARTMENT
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NUMBER OF STORIES NUMBER OF
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�,e4 L.-_ UNITS
NATURE OF WORK TO BE DONE
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(Or
Plan Check N
BUILDING
Valuation Fee Receipt No.
// ?J 2 C
77 !n
1
f
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C, PROPOSED USE
'y7
PLUMBING
I
FIRE ZONE I TYPE OF CONNSTAUCTiON STREET IMPROVED
W PLOT PLAN (Indicate Building Setbacks, abutting streets)
HEAT A GAS LINE
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SPECIAL INSPEC��T�ORR REQUIRED OCCUPANCY SOUP
I,�
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LINE
El RESIDENTIAL GASIN
❑X NEW L
❑ NON-RESIDENTIAL SIGN
ADD ❑ DEMOLISH O WALL VINO
ALTER ❑ OCFILLE.AVATE EI(ENCE
x .......... Ft.)
❑ YES �'NO d' /
PLAN CRECHEDY THIS SITE IS LOCATED IN THE CITY
, % SH EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
MA 8
El REPAIR
❑
PRE.SWINT
INRBPAfOVE
❑
POOL
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NUMBER OF STORIES NUMBER OF
,•�_ DWELLING
�,e4 L.-_ UNITS
NATURE OF WORK TO BE DONE
r 1%1'1'y A1=4%
(Or
Plan Check N
BUILDING
Valuation Fee Receipt No.
// ?J 2 C
77 !n
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DEMOLITION
PRE -MOVE INSPECTION
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TOTAL AMOUNT DUE
I hereby acknowledge that I hava rend this application; that the In-
formation given Is correct; and that I = the owner, or the duty author-
Ized agent of the owner. I agree to comply with city andelate taws regu
ATTENTION
APPLICATION APPROVAL
lating eonatructlon; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Weshington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE K
WORK NOTED
ut d fees receipt Is ac- —
finees are pa, anrep
shotl be completed In ninety days; MOVED -IN BUILDINGS shall be com-
kno wledged In space provided. i
pleled in els month..)
SIGNATURE (OWNER OR AGENT)DATE .SIGNED
INSPECTION
I CTOR'B S1(�NA RE
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DEPARTMENT
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CITY OF
EDMO
DATE 1
NOTE: Applicant Subject to Plan Check Fee
_ 5
775.2525525
This i'ernut covers work to by done an private properly ONLY.
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