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BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
5AE
a / 7 - We W Pj- % -_'T I -
Ir TELEPHONE NUMBEF
xo"'O/YPS I ek 6 - x1 -'Y-0 7
PERMIT
NUMBER
6%188
J
YA-4/
GET SETBACK RELAA YAUV SETBACK
fy)i A-%
VACANT SITE
j"ER
13 YES NO
XING AREA VARIANCE
04
M;Wrg / " DEFICIENCY THIS PROPERTY
STREET R/W
CITY TELEPHONE NUMBER
COUP. PLAN ST. R/W ........ .. XT-
REMARKS
NAME
0VV1VJ5/V_
94
ADDRESS
CHECKED BY
CITY
17101aurHONE NUMBER
MMTER SIZE SERVICE SIZE CLEARANCE CHECKED BY
03
STATE LICENSE NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four iez)
'Lo r /0 V/)=,W 1MAA1.0'fZ_
TYPE CONNECTION VERIFIED BY
X
_9E_RC. TEST PERMT NUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
0 YES 13 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
13 YES 13 NO
GAS
IMF
NEW
PLAN CREC D
I IqON R
[![Ell ;ON -RESIDENTIAL F� SIGN
ADD RETAINING
DDEMOLISH El WALL
ALTER EXCAVATE PENCE
OR FILL El .. ....... Ft.)
REPAIR PRE -MOVE SWIM
M INSP. E] POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WO TO BE DONE
Valuation Fee Receipt No.
Z
Plan Check No ............... ....
PROPOSED USE
BUILDING �C7
PLOT PLAN (Indicate Building setbacks, abutting streets)
PLUMBING
REAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIM31ING POOL
DEMOLITION
PRE -MOVE: INSPECTION
EXCAVATION OR FILL
ToTAL.AMOUNT DUE A�Jjr
I hereby ackaowledge 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 law# regu-
ATTFAMON APPLICATION APPROVAL
I&ting 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 PERMT This application is not a permit until
relating to WorkineWs Compensation I=umnc0-
AUTHORIZES signed by the Building Official or his Dep-
NOTE: permit Limit One Year (Except DEBIOLITIONS which
ONLY THE
WORK NOTED uty; and fees are paid, and receipt Is ac.
shall be completed in ninety days; MOVED -IN BUILDINGS shall be core.
lmowledged in space provided.
plated in a months.)
INSPECTION DIRECTOR'S SIG U
SIONAT (OWNER 0 AGENT)
E
DATE IGN7
DEPARTMENT
OF
CITY
DATE
EDMONDS
7-OTE: Applicant Subject to Plan Check Fee
N
PR 6-1107
This Permit coverg work to be done on private property ONLY.
Amy construction ca the public domain (cubs, sidewalks, driveways,
Fnln
marquess, etc.) win require separate permission-
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