670394.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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TELEPHONE NUMBXR
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NAME
ADDRESS
CITY
TELEPHONE NUMBER
NAME
ADDRESS
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CITY
TELEPHONE NUMBER
STATE LICENSE NUMBER
CITY LICENSE NUMBER
(RR 3-0/ —Geo
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4—Lic1W
NEW
ADD
ALTER
REPAIR
RESIDENTIA :NTIAL
NON -RESIDE
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
W
D
GAS
LINE
SIGN
RETAINING
WALL
PENCE
( .......... x .......... Ft.)
SWIM
POOL
4UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
voBTED__ON KROLL MAP NO.: PERMIT
c NUMBER '70394
JOB ADDRESS
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SIDE YARD SETBACK STREET SETBACK REAR YARD SETBJ
n-) S
USE ZONE LOT AREA VACANT SITE
0j, b i 1 [3 YES Ij NO
PLA IAIP VED
I
'T n/W
'ING STREET R/W
DEFICIENCY THIS PROPERTY
[P. PLAN ST. R/W., .. 0 .. FT.
.... e.FT.
a SIZE SERVICE SIZE CLEARANCE
C
I
6RHs
CON14ECTION VERIFIEV
V
TEST PERMIT IF
[I YES
PLAN CHECKU
REMARK4Y,/
Plan Check No .....................
Plan check I
PROPOSED USE
5
LDING
BUILDING
UI
PLUMBING
PLUMBING
PLOT PLAN (Indicate Buildlng,�etbacks, abutting streets)
Ca
0
HEAT & GAS LINE
AT & CA
PENCE
PENCE
'4
N
SIGN
IB
RETAINING WALL
C
SWIMMING POOL
V)
DEMOLITION
P PR -
RE MOVE INSPECTION
I
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I
.4bl(viffead this application; that the In-
formation given In 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 Coda 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; IMOVED-IN BUILDINGS shall be com.
pleted In six months.)
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NOTE: Applicant Subjcct to Plan Check Fcc
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveway%,
nuwquees, etc.) will require separate permission.
ATMNTION
THIS PERMIT
AUTHORIZES
ONLY THE
%VORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
[] YES
APPLICATION APPROVAL
a
94
Z
No.
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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RECORD OF INSPECTIONS
Date Paned
Foundation
Plumbing (Partial)
(Rough)
Aj
Frame
Furnace & Fuel Une—
S Aj
Final
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