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PERMIT APPLICATION ftdde Heavy Lines
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ID ON KROLL MAP NO.:
NUMBER
PERMIT 690022
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YARD SETBACK STREET SETBACK REAR YARD BETBA,
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ZONE LOT AREA VACANT SITE
1 11 A 1`1 Yzs %121NO
EXISTING -STREET R/W DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W .... ....... FT. ..._J".
13 YES
Plan Check
-PROPOSED USE-
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BUILDING
PLUMBING
-FE-0-T PLAN (Indicate Building setbackCrUpa
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33EAT & GAS LINE
FENCE
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given In correct; and that I am the owner. or the duly author-
lzed"agent of the owner. I agree to comply with city and state laws reffu-
ATTENTION
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
THIS PERMIT
retailing to Workmen's Compensation Insurance.
AUTHOVJZM
NOTE: Permit Umit One Your (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
1IGNATURE (OWNER OR
OENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Appfi"nt Subject to Plan Check Fee
PS 6-1107
This Permit coven work to be d0n6 an privafe property ONLY.
Any construction an the pubHo domain (curb$, sidewalks, driveways,
marQuees, ate.) will require separate Permtselom
—AJ 113YEB 13 NO
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.
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