660558.pdfA 41
BUILDING DEPARTMENT
,,,,J,,,Aicant FW
PERMIT APPLIC ATION
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NAMM (OR NAMIC OF BURINMO)
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TIMSPRONE NUMBER
NAME
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TELEPHONE NUMBER
NAMM
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CITY
BTATM LIUMN1030 NUMASIM
CITY LICENSE NU �ZK
3 — d 4��6,3
lAgal 1:)escription or rroPertY (Show Bel or Attach Four Copies)
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91
A4* 7^ 6 &roet o/
h e� e_.4�
F1 GASE
El NEW 10 RESIDENTIAL LIN
NON-RESIDENTIAL JF� SIGN
RETAINING
El DEMOLISH
WALL
ALTER EXCAVATE
OR PILL
El PENCE
......... x .......... FQ
REPAIR PRE -MOVE
INSP.
SWIM
F-1 POOL
DWEL1.JNG
UNITS
I hereby mmnowledge that I have read this application; that the In-
forme,tion given is correct; and that I am the Owner, or the duly author-
tZed agent of the owner. I agree to comply with city and state laws r1gu-
I-tin construction; and in doing the work authorized thereby, no person
WIU be OmPlOYed in violation of the Labor Code of the State of Washington
rolating to Workmen's Compsexation Insurance.
NOTE: P erWit Limit One Your (Except DEMOIJTIONS which
sb&u be completed in ninety days; MOVED.IN BUKMINGS shall be com-
pleted In six months.)
x5d_44
NOTE1 APPlicant Subject to Plan Cbech Fee
-----------
This Perrall covers work to be done m private property ONLY.
Any oonstrUetien an the publiC dornaln (curb*, sidewalks, driveways,
marque", eto.) win require separate perrnission.
EXISTING STREET R/W ........... XT-
COMP. PI" ST. RIW ............ FT.
0 YES
FNIM,
Plan Check No ............ . .....
BUILDING
FLUM33ING
IIEAT & GAB LM*TE
FENCE
SIGN
RETAINING WALL
SWIM30NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTEPMON
TEUS PERMIT
AUMOR171
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
60558
13 YES [3 NO
DEFICIENCY TM6 PROPERTr
(3 YES 0 NO
Z
tOUP
Fee
M_
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APPLICATION APPROVAL
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.
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