690375.pdfC
POSTED ON KROLL MAP NO.: PERMIT
0375
BUILDING DEPARTMENT Applicant Fill NUMBER 69
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711
PERMIT APPLICATION Inside Heavy Lines ju,3 ADDRE8S
Nr (OR NAME OF BUSINESS)
F2 (V r �it HETRACK
SIDE YARD SETBACK STREET SETEIJC:�
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MAILING A.VURESS
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C TY TELEPHONE NUMBER
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NAME
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ADDRESS
CITY TELEPHONE NUMBER
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le--n--ESIDENTIAL
GAS
LINE
NEW
DADD
DALTER
REPAIR
11
NON-RESMENTIAL
El
srGm
RETAINING
WALL
PENCE
( ........ . x ......... Ft.)
SWIM
POOL
DDEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
R OF
DWELLING
UNITS
0
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I hereby acknowledge that I have read this application; that the In-
formation given In 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-
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 DEBIOrATIONS which
shall be Completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
GENT) DATE SIGNED
OR
31ONATURE (OWNER 16-
NOTE: Applicant Subject to Plan Check- Fee
This Permit covers vrork to be done on private property ONLY.
Any construction an the PublJo domain (curbs, sidewalks, driveways,
marquees, etc.) wJU require separate permission.
Al
r6m
C] NO
[UMnMR ck
)'STREET R/W ... FT. DEFICIENCY THIS PROPERTY
PLAN ST. R/W k.;Z ... FT. ..a._..XT1
ted on Standard Drawing #103.
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ZONE I TYPE OF
WNW
Check No ............... . ...
& GAS LINE
INSPECTION
N OR FILL
13Y
0 YES
Fee
No.
AL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
TIUS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
uty; and fees are paid, and receipt is ac-
WORK NOTED
Imowledged in space provided.
INSPECTION
DIRECTOR'S
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
IF
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