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TELEPHONE NUMBER
VALUATION FEE
PLANNING DEPT. APPROVAL DATE
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NUMBER
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STREET AND/OR UTILITY ❑ YES
PERMIT APPLICATION
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UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
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APPLICATION APPROVAL
employed In vl.I.Ucn of the Labor Code of the slate Of WYhI¢gten
THIS PERMIT
This application is not a permit until
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to Workmen's Compensation Ineufnaee.
VARIANCE OR
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: Permit Limit One Year (E.Cepl DEMOLITIONS which
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TELEPHONE NUMBER
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NOTE: Applicant Subject to Plan Check Fee
NAME
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775-2525
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This Permit covers work to be done on private property ONLY.
Any construction on the doicurbs, sidewalks, driveways,
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ORIGINAL -File YELLOW -Inspector
ALLOWABLE
SIGN AREA
public
marquees, etc.) will require separate permission.
PROPOSED
SIGN AREA
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OTHER
REQUIREMENTS
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C CITY
TELEPHONE NUMBER
VALUATION FEE
PLANNING DEPT. APPROVAL DATE
<
❑ AOD
❑ ALTER
NAME
STREET R/W
a: f
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
O ADDR 5
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY w
❑OF
REPAIR
REMARKS—NE D
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WORK REQ, D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
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TYPE CONNECTION VERIFIED BY
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TOTAL AMOUNT DUE
REMARKS
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VALUATION FEE
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TYPE OF CONSTRUCTION
CODE
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RETAINING
❑ DEMOLISH ❑ \WALL
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❑ OR FILL ❑ (_ %_FTI
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
AREA
OCCUPANCY OCCUPANT
GROUP LOAD
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY w
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REPAIR
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UMBER OF STORIES
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NUMBER OF
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hereby acknowledge that I have read this sDDnCatlon; ilia! the In-
on given Ie correct; and that I am the owner, or the duly author-
nt of the owner. I agree to comply with city and elate lava ngu-
coaetructlon: and In doing the work authorized thenby, no penes
[mit
ATTENTION
APPLICATION APPROVAL
employed In vl.I.Ucn of the Labor Code of the slate Of WYhI¢gten
THIS PERMIT
This application is not a permit until
to Workmen's Compensation Ineufnaee.
AUTHORIZES
signed by the Building official or his Dep -
: Permit Limit One Year (E.Cepl DEMOLITIONS which
ONLY THE
uty; find fees are paid, and receipt is acn
completed fn moety days; MOVED -IN BDILDINOB shall bs com•WORK
NOTED
icnowledged to space provided.
six month$.)
INSPECTION
URE (OWNER OR AGENT) GATE SIGNED
OEPARTMENT
DI E O •S
IGNA UR
CITY OF
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EDMONDS
NOTE: Applicant Subject to Plan Check Fee
GATE
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775-2525
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This Permit covers work to be done on private property ONLY.
Any construction on the doicurbs, sidewalks, driveways,
ORIGINAL -File YELLOW -Inspector
public
marquees, etc.) will require separate permission.
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