680144.pdfC
BUILDING DEPARTMENT APPILICant Fin
PERMIT APPLICATION Inaide Heavy unes
NAMS (Olt NAN210-9 BUSINIGS15)
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MAILING ADDRESO
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1,709 M 44-
3 STREET R/W ......... XT.
PLAN ST. R/W ....... .... FT.
144
MANT RITM A
YES 13 NO 111
JUARCE NUMBER
DEFICIENCY THIS PROPERTY
YES 13 NO
I
GAG
RESIDENTIAL LINE
13 YES 0 NO
PLAN CHECKED BY
E] NEW
NON-RESIDENTIAL SIGN
ADD RETAINING
REMARKS
E] DEMOLISH WALL
E] ALTER EXCAVATE FENCE
OR FILL El ( X In.)
........ . .........
0 PRE -MOVE SWIM
REPAIR INSP. El POOL
NUMBER OF STORIES
NUMBER or
DWELLING
UNITO
NATURE OF WORK TO BE DONE
-stove. gw e 0*'-rep,� 5
Valuation
Fee
Receipt No.
_Al2
_
Plan check No..._ .........
BUILDING
Ole"
on
PLOT PLAN (Indicate Build;;�t"=_ abutting streets)
PLUMBING
33EAT & GAS LUTE
FENCE
t
SIGN
N
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRIG -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge Mat I have read this applIoLtIon; that the In-
formation given is correct; and that I am the owner, or the duly author-
Ixed agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
laUns construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
TMS PERMIT
This application is not a perndt until
relating to Workmen's Compensation Insurance.
AUTI[ORUES
signed by the Building official or his Dep-
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN NUELDINGS Aball be oom-
knowledged in space provided.
plated In six months.)
SIGN�LyViqt (OWNER OR AGENT) DATE SIGNED
INSPECTION
Dim HIS SIGN
DEPARTMENT
/Z�'
CITY OF
EDMONDS
D
NOTE: Applicant Subject to Plan Check Fee
PE 6-1107
This renuit covers work to be done an private Property ONLY -
AM construction an the public domain (curbs, sidewalks, drivewarh
FILE
marquees, aft.) will require separate permission.
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