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FED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant FIU Pof' / 'I Q) I NUMBER. 66058
PERMIT APPLICATION Inside Heavy Line JOB ADDRESS , -&', 4 / ---a V — Ae � C�r� -
Mff )ro Wk e"eje, R
0 ADDRESS
-,tkAA�r�, --go USE ZONE LOT AREA VACANT SITE
C CITY TELEPHONE NUMBER 13 YES NO
VARIANCE
HEIGHT-- BUILDING AREA NUMBER Pw
NAME
PLOT PLAN APPROVED
ADDRESS STREET H/W
CITY TELEPHONE NUMBER EXISTING STREET R/W ............ Fr. DEFICIENCY THIS PROPERTY 0
COUP. PLAN ST. R/W ............ FT. ....... .... 17.
REMARKS
NAME
CHECKED BY
z
ADDRESS
CITY TELEPHONE NUMBER METER SIZ10 SERVICE SIZE CLEARANCE CHECKED BY C111
IREMARKS
STATE LICENSE NUMBER CITY LICENSE NUMBER
TYPE CONNECTION VERIFIED BY
Legal Description of Property (Show Below or Attach Four Copies)
/-Ot' -51 /f,01,Wcesi &,Z;r141 PERC. TEST PERMIT NUMBER
& 'IM6 AIWS &-j 4 REMARKS
Ed
A F7RE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
13 YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
[] YES [] NO
PLAN CHECKED BY
GAS
NEW RESIDENTIAL LINE REMARKS
1 1:1 NON-RESIDENTIAL SIGN
ADD RETAINING
1:1 DEMOLISH WALL
ALTER EXCAVATE FENCE
11 OR FILL ( .......... x .......... I%.)
REPAIR PRE -MOVE SWIM
El INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WO!ff TO BE
a ot 5 i1jA // ;7en 1L-e- be iv c,
_rN & i-fi Ile C1
�gc-/4�-
Plan Check No ..........
I
BUILDING
U L D I G
'4
P L
PLUMBING
MBI 'G
A 8 L I NE
HEAT & GAS LINE
H E A T G
F E N
PENCE
C E
t
I N
SIGN
G
RETAINING WALT
R E T AINI N G W A LL
SWIMMING POOL
SWIMMIN G POOL
DEMOLITION
PRE -MOVE INSPECTION
E EX
XCAVATION OR FILL
OTAL A. E
�JOUNT DU
T TOT L MOUNT DUE
1 n
I hereby acknowledge that I have read this application; that the In.
a u 0 r
formation given In correct: and that I am the owner, or the duly author-
re u-
lzed agent of the owner. I agree to comply with city and state laws regu-
g
ATTENTION
person
lating construction; and In doing the work authorized thereby, no person
2hington
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OMTIONS which
jcom.
ONLY THE
WORK NOTED
shall be completed In ninety days; AIOVED-IN BUILDINGS shall be
pleted/in six months.)
�!�TURE (OWNER DATE SIGNED
INSPECTION
.1 /
13
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (Curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation
.3.
1 3.0o lks-o�;
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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