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BUILDING DEPARTMENT Applicant M
PERMIT APPLICATION Inside Heavy Unes
F4
5_0
Cl YES
No
EXISTING'STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COUP. PLAN ST. R/W ............ FT- ........... TV -
I REMARKS
57/ 5? 77 040
I A/
at ?��- le- lma,% 41 - 1.4 0 71METER SIZE I SERVICE SIZE I CLEARANCE i CHECKEB-Ty"
EACENUE NUMBER CITY LICUNSE NUMBER I REMAHKII
ascriDtion of ProDertY (Show Below or Attach Four Copies)
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINING
WALL
DEMOLISH
E] ALTER
D
EXCAVATE
OR FILL
PENCE
( X Ft.)
........ . ..........
E] REPAIR
PRE -MOVE
INSP.
F�
SWIM
POOL
ES
NUMBEn UF
DWELLING
UNITS
Z�l
or
[] YES [j NO
Plan Check No ........ . ...........
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
tRETAINING
WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In.
formation given Is correct: and that I am the Owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regU- ATTENTION
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 PERMIT
nlatIng to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Your (Except DEMOLITIONS which WORK NOTED
&hall be completed In ninety days; MOVED -IN BUILDINGS shall be oom.
plated In etc monthsj
GNED INSPECTION
310 TURE (OWNER OR AGENT�_ DATE 01 DEPARTMENT
ejea6lz1aw CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PH 6-1107
1 This ]Permit coven work to be done on priva4e property ONLY.
Any construction an the pubtle domain (curb@, sidewalks, driveways,
mwquws, etc.) Will require separate permission.
[] YES 13 NO
Valuation
No.
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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PL INSPECTIONS
RECORD OF
Date Passed
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Foundation
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RECORD,OF.,INSPECTIONS
Date Passed,
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Parking
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PLandscaping
Fite Dept$ 1
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