750493.pdfVALUATION FEE
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LANZ�DEWROVAL O ATE
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BUILDING DEPARTMENT
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PERMIT
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1 hereby acknowledge that I have rend this application: that the in.
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STATE LICENSE NUMBER
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NAME (OR NAME OF BUSINESS)
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relating to Workmen'* Campenaatl0n Insurance.
AUTHORIZES
This application is not a permit until
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ONLY THE
LEGAL
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PERMIT NUMBER
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REMARKS
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METER SIZE
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LANZ�DEWROVAL O ATE
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1 hereby acknowledge that I have rend this application: that the in.
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CITY
TELEPHONE NUMBER
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lating Conatructloa; and In doing the work authorlaed thereby, no person
ATTENTION
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
relating to Workmen'* Campenaatl0n Insurance.
AUTHORIZES
This application is not a permit until
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NOTE: Permit Limit One Year (EICePt DEMOLITIONS Which
ONLY THE
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WORN NOTED
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES
Pleled In els months.)
knowledged in space provided.INSPECTION
WORK REQ'D ❑ NO
SIG TORE (OWNER OR AG EN IZZ DATE SIGNED
DEPARTMENT
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SEPTIC SYSTEM ❑ YES
APPVD BY CITY ENG. ❑ NO
PERMIT NUMBER
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REMARKS
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Any canstruet;on on the public domain (curbs, sidewalks, drivoways,
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marquees, otc.) will require Separate parmisslon.
METER SIZE
SERVICE SIZE
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❑ ALTER ❑ EXCAVATE FENCE
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PLAN c E ED eY THIS SITE IS LOCATED IN THE CITY
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1 hereby acknowledge that I have rend this application: that the in.
TOTAL AMOUNT DUE
formation given le correct; and that 1 nm the owner, or the duly eelhw-
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tied agent at the owner. I agree to Comply with city and stat* laws rose.
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lating Conatructloa; and In doing the work authorlaed thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation at the Labor Cade of the Btats of Washington
THIS PERMIT
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relating to Workmen'* Campenaatl0n Insurance.
AUTHORIZES
This application is not a permit until
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NOTE: Permit Limit One Year (EICePt DEMOLITIONS Which
ONLY THE
signed by the Building Official or his Dep-
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shall he completed In ninety days; MOVED -IN BUILDINGS shall be wm-
WORN NOTED
uty; and fees are paid, and receipt is ac-
Pleled In els months.)
knowledged in space provided.INSPECTION
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SIG TORE (OWNER OR AG EN IZZ DATE SIGNED
DEPARTMENT
1-1 A
O EC R S GNA URE
CITY OF
EDMONDS
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NOTE: Applicant Subjectto Plan Check Fee
DATE /
775-2525
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This Permit covers work to be done on private Property ONLV,
Any canstruet;on on the public domain (curbs, sidewalks, drivoways,
ORIGINAL -File YELLOW - Inspeclar
marquees, otc.) will require Separate parmisslon.
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