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ApplIcant Fill
BUILDING DEPARTMENT inside 11cavy Lines
PERMIT APPLICATION
3N YARD 81
MAILING ADIJItk�bU
CITY — KELEPHONE NUMBER
17,2 7
IAP NO.: PERMIT
I NUMBER 690397
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ADDRESS
STREET R1W
:3 CITY TELEPIIONE NUM13ER EXISTING STREET n/W .4#2�.FT.
4 1 1 COMP. PLAN ST. R/W .6.P..FT.
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indicated on Sti
ADDRESS
CITY TELEPHONE-MU—MBER
METER SIZE I SERVICE I
STATE UCENSE NUMBER CITY LICENSE NUAWM" I __X/ - _3/c/ 1(
or Attach Four
NEW
L�Xj
RESIDENTIAL I
L-i
LINE
1
1:1 NON-RESIDENTIALI
EJ
SIGN
RETAINING
WALL
1:1
DEMOLISH
ALTER EXCAVATE
n OR FILL
El
FENCE
( ........ . x .......... Ft.
REPAIR PRE -MOVE
E] INSP.
swim
POOL
'N—UMBER Or STORIES
NUMBER OF
2—
DWELLING
UNITS
'WA—TURE OF WORK TO BE DONE
ICK REA" YARL) NNK"TCK
VTCANT _81TE
&YE [0] N 0
_ a I
"A RIANCE riubiuzll
DEFICIENCY THIS PROPERTY
TYPE CONNECTION
VERIFIED BY
PERC. TEST
PERMIT flUMBER
REMARKS
FIRE ZONE TYPE OF CONSTRUCTION
-W:::- _77
STREET IMPROVED
0 YES NO_
SPECIAL INSPECTOR REQUIRED
0 YES N$(�O
OCCUPANYROUP
t
PLAN CHECKEO BY
REMARKS
Plan Check No .........
Jon
Fee
Eecel�t Noa
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USE
LN (Indicate Building setbacks, abutting streets)
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I hereby acknowledge that I have read this application; that the In-
formation g1ven 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 Vimit One Year (Except DEMOLITIONS which
shall be completed In ninety days; BUELDtNGS shall be com-
Meted In six months.) ��T
.40TE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an private PrOPertY ONLY -
Any construction on the public domain (cwbx. sidewalks, driveways,
nuuMuces, etc.) win require separate permission.
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PH 0-1107
M1011001917
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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FILE
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