670303.pdf7- n",
Imam= POSTED ON KROLL MAP No.: PERMIT
nHlinimir% nrPARTMFNT I NUMBER 670303
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
PON ah"AIMER
MAILING ADDRE9S
CITY
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INONIRESIDENTJIAL
SIGIIN
ADD
RETAINING
WALL
DEMOLISH
EXCAVATE
FENCE
ALTER
OR BILL
( X Ft.)
.......... ..........
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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I hereby acknowledgo that I have read this application; that the in-
formation given 13 correct; and that I am the owner, or the duly nutbor-
Ized. agent of the owner. I agree to comply with city and state laws regu-
lating constMCUOn; and In doing the work authorized thereby, no person
will be employed in violation Of the Labor Code of the State of Washington
relaung to Workmenos 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.)
S
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on privnte property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvmvnyx,
marquees, etc.) will require separate permission.
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EXISTING STREET R/W ............ FT.
cOMP. PLAN ST. R/W ............ FIT.
C] YES 13 NO
Plan Check No .....
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
VACANT SITE
YES NO
MA VARIANFIS NUMBER
DEFICIENCY THIS PROPERTY I �
Valuation
[3 YES [3 NO
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PER1%nT This application is not a perinit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY TIIE
WORK NOTED uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
INSPECTION _DIREC 0 IS SIGNATUR&
DEPARTMENT 10,
CITY OF
DATE
EDMONDS
Pn o-iiw � �30
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