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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines joB
NAME
(OR NAME OF BUSINESS)
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SID
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MAILING ADDRESS
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CAY
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TELEPHONE NUMBER
7;�5 70
NAME
PL(
54
ADDRESS
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EX
CITY T PHONE NUMBER
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NAME
24
_XDDRESS
CITY
TELEPHONE NUMBER
�7 NUMBER CITY LICENSE NUMBER
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Legal Description OT—property (Show Below or Attach Four Copies)
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GAS
RESIDENTIAL F-1 LINE
1:
DNEW
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ElNON-RESIDENTI&L SIGN
ErADD RETAINING
WALL
13
ElDEMOLISH
ALTER EXCAVATE El PENCE
F� OR FILL ( ........ . x . ........ Ft.
REPAIR PRE -MOVE SWIM
El INSP. El POOL
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO B DONE
Z
PROPOSED USE/
abutting streets)
P
PLOT PLAN (Indicate Building actbacks,
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I hereby acknowledge that I have read this application; that the In.
formation given Is correct; and that I Wn 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 DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
SIGNATURE (OWNER Oki AGENT)
DATE SIGNED
NOTE: APP * ant Subject to Plan Check Fee
This remit coven work to be done an private property ONLY.
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate pftmilsslon.
TED ON KROLL MAP NO.: PERMIT
NUMBER
—7
00047
ADDRESS
jjo/—
E Y D SETBACK STREET SETBACK
HEAR YARD SETBACK
E ZONE
LOT AREA
VACANW SITE
14
S S
13 YES 0
I ON
I
I
I VARIAINUN IMBER
iT PLAN -APPROVED
MET R/W
[STING STREET R/W ........... YT. DEFICIENCY THIS PROPERTY
OMP. PLAN ST. R/W ............ FT. ............ TV.
NEARKS
Z
NECKED BY
,T M- SIZE SERVICE SIZE CLEARANCE
33Y
I
rIlECKED
cd
;MARKS
�PE CONNECTION
VERIFIED BY
TEST
PERMIT NUMBER
�MARKS
ME ZONE TYPE OF CONSTRUCTION
bTJKZt;T 1&1k'1tUvZU
I YES Ej NO
'ECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
YES [3 NO
LAN CHECKED BY
EMARKS
Valuation
Fee
Receipt No.
Ian Check No ............ ... ....
IUILDING
ILUMBING
IEAT & GAS LINE
ZEN=
NON
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE.MoVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
Signed by the Building Off Icial or his Dep-
ONLY THE
uty; and fees are paid, and receipt Is ac-
WORK NOTED
knowledged in space provided.
INSPECTION
DIRECTOWS IGk
DEPARTMENT
CITY OF
EDMONDS
L
PR 6-1107
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