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POSTED ON KROLL MAP No.: PERMIT
NUMBER
RTMINT Applicant Fill
BUILDING DEPA
Inside Heavy Lines JOB ADDRESS
PERMIT APPLICATION
NAME ( R NAME OF BUSINESS)
K STREET SETWACK YAMD UET13ACK
SIDE YARD SETUAC RE
14. Ahc eAJ
MAILING ADDRESS
—VA—CANT SITE
9813 -ZONE LOT A.REA
0
z
-'VELEPRONE NUMB)", n YES (3 NO
CITY FS — I I
B PW
HErUHT VARIANCE NUM
uu�ING AREA
4CFJ/A 6 OJZ Ifle, .8 (wa.;1A
NAME
_9L_0T PLAN APPROVED
ADDRESS
STREET BIW
EXISTING STREET R/W ------- XT. DEFICIENCY T3118 PROPERTY
CITY PHONE, NUMBEAS
COUP. PLAN ST. R/W ........ ... FT. ........
ME —MARKS
NAMM
ADDRESS
5 co - CIL
CITY T EPHONE NUMBER
09 1 (z
ry METER SIZE SERVICE SIZE CLEARANCE CIL
STATE LICENSE NUMBER CITY LICENSE NUMBER
1.223o)� - 396o REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION VERIFIED BY
PERO. TEST PERMIT NUMB]
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION
SPECIAL INSPECTOR REQUIRED OCCUPANCY G1
GAS 0 YES [3 140
ElNEW RESIDENTIAL El LINE PLAN CHECKED BY
ElNON-RESMENTIAL SIGN
kDD RETAINING REMARKS I
DEMOLISH LJ WALL
ALTER EXCAVATE
OR IF7LL "4 Jsx;l
REPAIR PRE -MOVE swim
El INSP. El POOL
DWELLING
UNITS
Plan Check
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
I hereby acknowledge that I have read this application; that the In-
formation given is 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 regu-
lating construction; and In doing the work authorized thereby. no Person
will be employed In violation Of the Labor Code Of the Biala Of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shalt be Completed in ninety days; MOVED -IN BUILDINGS shall be com-
plated J12 six months.)
W4 A, 7F;;_ %� � R- "M
NOTE: Applicant Subject to Plan Check Fee
This Permit covers Work to be done On PrITAIle property ONLY.
Any canstructioa on th6 public domain (curb@* sidewalks# drivewayso
marquees, etc.) will require separate permission.
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS rEn5fIT This application is not a permit until
AUTHORIZES eigned by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PE 6-1107
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