690149.pdfBUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION Inside Heavy Lines
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C4 NAME (OR NAME OF BUS
2AU-41IG ADDRESS
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NEW
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RESIDENTIAL
El
GAS
LINE
NON-RESIDENTrAL
SIGN
RETAINING
DDEMOLISH
WALL
ALTER
n
EXCAVATE
OR FILL
FENCE
( x Ft.)
........ . . ........
REPAIR
1:1
PRE -MOVE
INSP.
swim
POOL
DWELLING
UNITS
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I hereby acknowledge that I have read this application; that the In-
formation given Is correct; and that I arn 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 Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DE51011TIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
pleted in six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private Property ONLY.
Amy construction on the Public domain (curbs, sidewalks, driveways.
marqu"s. etc.) will require separate permission.
ON KROLL MAP NO. 1
PERMIT
690149
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1 NUMBER
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MD SETBACK
STREET SETBACK
HEAR YARD SETBACK
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LOT AREA
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I BUILDING AREA
I VARIANCE NUMB,
GSTI*d STREET R/W ......... XV.
COUP. PLAN ST. R/W ........ .. XT.
TYPE
[] YES
Plan Check No .......
DEFICIENCY THIS PROPERTY
cd
0 YES
roe I Receipt No.
BUILDING
C)O
A7.00
PLUMBING
1900
HEAT & GAS LINE E L
FENCE
SIGN
RETAINING WALL
SWIM NG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
Tills application Is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in apace provided.
INSPECTION
11 SIONA U
DLRECTOR'S BIG
DEPARTMENT
:�
01
CITY OF
EDMONDS
DAT4
C�_,
�L
PH 6-1101
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