670028.pdfBUILDINiF DEPARTMENT Applicant F111
Inside Heavy Lines
PERMIT APPLICATION
NAME (OR NAM OF BUSINESS)
MAILJNG ADDRESS
9 -7 7672' 1'//,
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CITY TELEPHONE NUMBER
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NAME
IOSTED ON KROLL MAL' NU.: PERMIT
NUMBER
670028
OB ADDRESS
,�2 nZ_ I P / -
51DE YARD SETBAUA. bifti-i= SETBACK REAR YARD SETBACK
_V_ACANT SITE
USE ZONE lul YES 0 NO
REIGHT BUILDING AREA VARIANCE NUMBER 04
P T PLAN APPROVED
ADDRESS
CITY TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............ FT- DEFICIENCY THIS PROPERTY
COMP. PLAN ST. n/W ............ Fr- ............ FT.
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REMARKS
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NAME
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CITY
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TELEPHONE NUMBER
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REMARKS
—F-C—ITYLICENSE
STATE LIC414815 NUMBER
NUMBER
TYPE CONNECTION
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Legal Description of Property (Show Below Or Attach Four Copies)
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PERO. TEST
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES 13 NO
SPECIAL INSPECTOR REQUIRED
NO
OCCUPANCY GROUP
PLAN CHECKED BY
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NEW
GAS
RESIDENTIAL LINE
NON -RE El
1 1:1 SIDENTIJ E] SIGN
REMARKS
All construction to comply With the
Li ADD
RETAINING
WALL
1:1
DEMOLISH
UBC
ALTER
EXCAVATE
OR FILL
ED
PENCE
( .......... X .......... Ft.)
REPAIR
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PRE -MOVE
INSP.
F�
SWIM
POOL
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DWELLING
UNITS
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Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
P
I
RETAINING WALT
S SWIMMING POOL
DENI.OLITION
FRE-MOVE INSPECTION
E I
XCAVATION OR FILL
Valuation
Fee
H
No.
I
T
TOTAL AMOUNT DUE
TO" A " 0 U'
i
I hereby acknowledge that I have read this application; that the in-
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o v
'
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-
r
ALTTENTION
't' T T
APPLICATION APPROVAL
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
E R 51
THIS PERMIT
T 11 IS
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTIIOn1iZE8
I TI
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
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WORK NOTED
rDEPARTMENT
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days: IkIOVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted in nix months.)
SIGNATURE (UNYNN" u" Avz111) DATE SIGNED
INSPECTION
E T3.JE
DIRE T S SIONA u
0]
C
DATE
CITY -
CI �j
EDMONDS
NOTE: Applicant Sitbject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
FILE
marquees, etc.) will require separate permission.