670567.pdfI
BUILDING DEPARTMENT
PCKMII APPLILAII N
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NAMN
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-ADDRESS
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STATE LICENRic NLTXBZR
Applicant FM
Inside Heavy Lines
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or
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FA
El
RESIDENTIAL
M
GAS
LINE
NEW
ElRETAINING
NON-RESIDENTLAM
RSIGN
D
DEMOLISH
WALL
ALTER
EXCAVATE
OR FILL
1E
REPAIR
n
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
Ts-0-s- -
EXISTING STREET R/W ........ ... FT.
COMP. PLAN ST. R/W ........... .1-r.
0 YES
Plan Check No ................ ...
BUILDING
PLUMBING
HEAT & GAS LINE
PEN CE
SIGEN
T
RETAINING W:AJLL
N
S SWrMM P OL
WrMMING POOL
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 agres to comply with city and state laws rogu.
lating conxtructIon; 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 Workman'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.)
2-4�-4-7
NOTE: Applicant Subject to Plan Check- Fee
This Permit covers work to be done on private ProPerty ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
raarquees, etc.) will require separate permission.
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
PERMIT
NUMBER 670567
e- 1044s.-,
E3 YES [3 NO
DEFICIENCY THIS PROPERTY
Valuation
[3 YES 0 No
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ATTENTION APPLICATION APPROVAL
TMS PER1%UT
AUTHORXZES This application is not a per7nit until
ONLY THE signed by the Building Official or his Dep-
ITORK NOTED uty; and fees are paid, and receipt is ac-
xnowledged in space provided.
INSPECTION
DEPARTMENT D12M
CITY OF
EDIVIONDS
PR 0-1107
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