690225.pdfI Nit 'Mr POSTED m-KROLL MAP NO.: PERMIT
NUMBER
BUILDING DEPARTMENT Applicant Fill 1 690225
PERMIT APPLICATIO N Inside 11cavy Lines I joB ADDRE88
NAME (OR NAME OF BUSLNEHs)
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GAS
LINE
NON-RESIDENVIAL
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ElDEMOLISH
EXCAVATE
OR FILL
RETAINING
WALL
PENCE
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PRE -MOVE
INSP.
0 SP WOOI Mr
DWELLING
UNITS
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PLOT PLAN (Indicate Building Setbacks, abutting streets)
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I hereby acknowledge that I have read this application; that the In-
formation given is correct; and that I am the owner. or the duty 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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom-
plated in six months.)
NOTE: Applicant Subject to Plan Check Fee
This permit covers work to be done on private property ONLY.
Any oonstructlon on the public domain (curbs, sidewalks, driveways,
marquess, etc.) wilt require separate permimidon.
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EXISTING STREET R/W ............ FIT.
COMP. PLAN ST. RAV ........... Irr.
[] YES [3 NO
DEFICIENCY THIS PROPERTY
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ERC. TEST PERMIT NUMBER
EMARKS
OK to connect into sanitary sewer but with n4
larger line than 2".
IRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
P,9-,* 0 YES [3 NO
C1 YES [] NO
Plan Check No ........
BurimiNG
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTnOR1ZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PIL 0-110
Valuation
Fee
I
No.
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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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