670084.pdf- OSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill /.a 0 g I NUMBER
PERMIT APPLICATION Inside Heavy Lines
ME (OR NAME OF BUSINESS)
MAILING ADDREUS
C
- LITY
TELEPHONE NUMBER
NAME
CITY
TELEPHONE NUMBER
NAME
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ADDRESS
CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
YARD SETBACK STRE
70084
R YARD BE
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a NO
PROPERTY
EXISTING STREET R/W ............ FT- DEFICIENCY THIS
COMP. PLAN ST. R/W ............ FT- ...
REMARKS
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Legal Description of Property (Show Below
or Attach Four Copies)
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050
W
GAS
NEW RESIDENTIAL LJNB
NON-RESIDENTIA.L
IAL f SIGN
F� ADD
ElDEMOLISH
RETAINING
WALL
0 ALTER EXCAVATE
0 OR FILL
PENCE
0 ( x
.......... ..........
REPAIR PRE -MOVE
D INSP.
swim
POOL
I`IUMBER OF
DWELLING
U NITS
NA URE OF WORK TO 13E DONE
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PERC. TEST
REMARICS
FIRE ZONE TYPE OF CONrTR"U'
0 YES
0 YES _-z
PLAN C
MA&UW
Plan Check No ............ . .......
P I n C h e c k N 0
E PROPOSED USE
I N G
BUILDING
B U I L D
MB I N G
PLUMBING
P L U
PLOT PLAN (indicate Building setbacks, abutting streets)
8 E
HEAT & GAS LINE
I A
rE A T G
F N C
FENCE
E 17
41__
N
I N
SIGN
G
NJ W A LL
RETAINING WALL
R E T AI 14G
POOL
SWIMMING POOL
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EMOLITION
D EMOLIT 0
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14
PRE -MOVE INSPECTION
J'i E
EXCAVATION OR FILL
UNT
TOTAL AMOUNT DUE
TOT L I to .
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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted In six months.)
IGNED
RONATURE (OWN R OR AGENT) DATE 8
NOTE: Applicant Subject to Plan Check Fee
—ibill —pemilt cover.: work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pernils5lon.
AT=NTION
THIS PETOUT
AUTHORIZES
ONLY TIES
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
Valuation
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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.