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P08TED ON KROLL MAP NO.: PERMIT 0334
UBUIL61NG DEPARTMENT Applicant Flll
PER
APPLICATION Inalde Heavy Lines JOB ADDRESS
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i
TELEPR'NE NUMBIc
1?7 —Sl�&
J / \ - • v V s G� Yt�
I—
or
RESIDENTIAL
GAS
F1 LINE
NEWINNON-RESIDENTIAL
❑ SIGN
ADD ElDEMOLISH
WALL KING
ALTER
❑
EXAVAT
OROFILL E
❑ FENC.x.......... Ft.)
❑
REPAIR
❑
INSP. 2.SOVE
WIM
❑ P OL
4UMBER OF STORIES
NUMBER OF
/
DWELLING
UNITS
BIDE YARD SETBACK
STREET SETBACK
REAR YARD SETBACK
d�)'-'a-
I 0 S
I ��
USE /ZONE
LOT AREA
VACANT SITE
IQS— e
v
I
DYES �NO
..-....—
, nnrr.ntrun AREA
I VARIANCE MBDR
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
TYPE OF CO
13 YES
PC
DEFICIENCY THIS PROPERTY
CiJ14-Ai4.65
YES �)6 NO
THIS SITE IS LOCATED IN TP E
CITY C1F E91atn E
REMARKS TAX SHOULD DE CODED 31.0 .
core 70
Valuation
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE NNN
SIGN
1 RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL ADIOUNT DUE
I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner, or the duly author-
----
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
TIUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days: )1LOVF.D-IN BUILDINGS shall be com-
pleted in six months.)
nGNATURE (OWNER Ott AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
- -71
I
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fce
PR 6.1107
This Permit covers work W be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Fee
3
M
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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ID
RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final
RECORD OF INSPECTIONS
s Date Passed
Drainage
Sewer .
Parking .
Landscaping
pt: Fire, De ,