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POBTED ON KROLL MAP NO.: �IT�A
",BUILDING DEPARTMENT ApplIcant MR
PERMIT APPLICATION Inside Heavy Lines
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RESIDENTIAL I
M
GAS
LINE
NEW
-RESIDENTIALI
El
SIGN
ADD
RETAIMNG
WALL
0
DEMOLISH
0 ALTER
0
EXCAVATE
OR FILL
PENCE
........ . X .......... Ft.)
REPAIR
PRE -MOVE
INSP.
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NUMBER OF
DWELLING
UNITS
PROPOSED U813
PLOT P �AN (Indicat�p Building Setbi
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N
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YARD BE
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NUMBER
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STREIdT BETBACK,
C2 5 1 0) L"r) -
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VACANT SITE 0 4
0 YES NO Z
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vARIANCE MUBElt lk
EXISTING STREET R/W ........... FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ PT.
REMARKS
OK to connect into sanitary sewers but
with no larger line tnan 21F.
[3 YES El No
REMARKS /-% A A
Plan Check No ............
BUILDING
PLUMBING
HEAT CGAS)JNE
PENCE
t
SIGN
RETA.INING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application: that the In-
r
formation given Is correct; and that I am the owner, or the duly author-
u
Ized agent of the owner. I agree to comply with city and state laws regu-
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ATMNTION
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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 PEIUIIT
relating to Workman's Compensation Insurance.
AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which
WORK NOTED
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
pleted in six months.)
JIGNATURE (OWNER _Oib AGEN DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDDIONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit ovez,s work to be done on privfttc property ONLY.
Any construction na the public domain (carbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
R U11
[3 YES 0 NO
Fee
P41
50J
l-,
No.
I / 5- a- �' IWI 7 -,
APPLICATION APPROVAL -
This application Is not a permit until
signed by tile Building official or his Dep-
uty; and fees are paid, and receipt is ac-
lmowledged in space provided.
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