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r' PLAN FILE NUMBER BUILDING
WillingPermit Application ll ppileallt �"` PERMIT ;
Inside Hen Lines NUMBER
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1 N OR N 0 OF BUBI EBB) JOB ADDRESS '.
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r . w', /MAILING ADDR 8 HIDE YARD 69&T YrACK REAR YARD -
'6• TELEPHONE NUMB -
O USE ZONE MAP NUMBER VACANT SITE ER
^i •C/ �' O I D YES ONO
i K^ NAME BUILDING AREA I LOT AREA I VARIANCE NUBMER
+� 1
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ADDRESS HEIGHT ti
ALL BUILDING SETBACKS .i
;z NOTE: 'TO EAVE LINES
CITY TELEPHONE NUMBER gF,MARI(g '
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(. NAME
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OND ADDRESS Encroachment Permit PERMIT NUMBER STREET.. GRADE CHECK ' i r
Required Z q.
. YES NO - J 0
pp CITY I TELEPHONE NUMBER METER SIZE I SERVICE SIZE CLEARANCE I CHECKED BY
_ STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS
` LOT BLOCK TRACT t '`
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TYPE CONNECTION VERIFIED BY,
PERC. TEST PERMIT NUMBER ty it
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FIRE ZONE TYPE OF CONSTRUCTION STREET ED.. It 11
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Xi YES NO I';:
` O SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP �-
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YES . ❑ NO �(rr
PLAN CHECKED BY
44
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! N . WO TO BE DONE
/ / NO. OF BLOCS. P[HLLoa. TOTAL pgg Z
M -� BUILDING O
1 - 1 VALVATION
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BUILDING PERMIT 1 .; i.',
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NUMBER OF STORIES 2 FEE �f.tj
NEW _ DEMOLISH PLUMB'
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3 PERMI
T FEE
ADD I
HEAT & GAB LINE ,r
I ALTER RESIDENTIAL I NUMBER OF S PERMIT FEE y n
REPAIR'. NON-RESIDENTIAL UNITS NG DEMOLITION *, r '
0 PERMIT FEE { 1
PROPOSED USE - ;.' -I It
S AMOUNDDUE
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I hereby acknowledge that I have read this application` that w°' ATTENTION APPLICATION APPROVAL
formation glven Lin correct; and that I. am the owner, or the duly author-
lzed agent of the owner. I agree to comply with city and State lawn Iegu• TIHg PERMIT t •' <
lating construction; and In doing the work authorized thereby, no person AUTHORIZES
This application 18 not 8 peTlriit until {. �.
will be employed In violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec- , _
retaUng to Workmea'e Compensation Insuraaoe. tion, or his deputy; and lees are aid and
WORK NOTED p yi paid,
NOTE: PERMIT LIMIT ONE YEAR receipt is acknowledged in Space provided
O R OR AG NT) DATE SIGNED INSPECTION DIRECT 8 G U �.�t
B1 ATURE (OWNER .. GN ( DEPARTMENT
Dir v yk, BI .Official
CITY OF
EDMONDS DATE
"•yam'.—y�-.K 3c Al ROVED J �.
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PR 5-1307 ;
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