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ZONE NUMBER 750434
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APPLICATION
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NAME
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ADDRESS
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NOTE: Applicant Subject to Plan C7:eck Fee
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775-2525
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CITY
TELEPHONE NUMBER
REQUIREMENTS
Any construction On the public domain (curbs, sidewalks, driveways,
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PLANNING DEPT. APPROVAL DATE
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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STREET AND/OR UTILITY ❑ YES
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WORK REO'D ❑ NO
UNDERGROUND ❑ YES
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WIRING REW'D ❑ NO
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TYPE CONNECTION VERIFIEO BY
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❑ NEW
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❑ DEMOLISH ❑
BPECIA L I N SPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
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ALTER E--AV—TC FENCE
ALTER
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REPAIR [:]PR E - MWIM
INSP. POOL
NUMBER OF STORIES NUMBER
DWELLING
UNITS
N T E OF WORK TO BE DONE
PROPOSED USE
❑ YES ❑ NO
PLAN CHECKED Br
REMARKS
PLAN CHECK
NO.
F
THIS SITE IS LOCATED IN THE CITY W
OF EDMONDS. LOCASALES TAX O
L
31 U,
Z
G
J
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VALUATION FEE -
-----
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1
6 PLOT PLAN INDICATE BUILDING SETBACKS,
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BUILDING!
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PLUMBING
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HEAT 6 GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
1:1eby acknowledge that I have read this application; that the In.
TOTAL AMOUNT DUE
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I. given le correct: and that I are the owner, or the duly SMU11—
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Ized agent of the owner. 8C1agree to comply with Cityand eta. las@ "go-
lating conetrectfon; and In doing the work authorized tber&by, no person
ATTENTION
APPLICATION APPROVAL '
will be employed In vfol.tt- of the Labor Code of th@ State of WYbington
THIS PERMIT
slating to Workmen's Compen&atlon Imurance,
This application is not a permit until
NOTE: Permit Limit One Year (Elcept DEMOLITIONS which
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep -
shall be completed In ninety day@; MOVED -IN BUILDINGS &hall be com-
WORK NOTED
utyi and fees are paid, and receipt Is ac-
pleted In al: moatha.)
knowledged In space provided.
S GN ATURE (OWNER OR AG ENTI DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTO I A E
CITY OF
EDMONDS
GATE -� ..-r ,
NOTE: Applicant Subject to Plan C7:eck Fee
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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 public domain (curbs, sidewalks, driveways,
ORIGINAL - Filc YELLOW - hupeclor
marquees, etc.) will require separate permission.
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