700052.pdfOUILUIMU UErJ41111TIF-11111 Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NA.ME OF BUSINESS)
4 .'
MAILING ADDRESS
C1 TELEPHONE NUMBER
NAME
1155D
P
CITY
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NEW
F—A
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
RETAINIriG
DEMOLISH
WALL
EXCAVATE
FENCE
ALTER
on FT"
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
W—UMBER OF 13TORIES
NUMBER OF
DIVELLING
UNITS
NATURE OF WORK TO,BE DONE
I /
1_1
Ik : I , �%
A/f
TN_ KROLL MAP NO.: PERMIT -7
1 NUMBER 100052
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USE ZONE LOT AREA T 81
13 YES 0 NO
HEIGHT I BUILDING AREA I vARiANcm NUMBER 04
E313STING STREET R/W ........ ... FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ........... X`T. ........... FT .
RE—KARKS
TYPE OF
[3 YES [] NO
6�_E Plan check No ............
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
B
P
tRETAINING WALL
I SWIUIUNG POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
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
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relating to Workman's Compensation Insurance. AUTHORIZES
TH
ONLY TILE
NL
I
NOTE: Permit Limit Oita Your (Except DEMOIATIONS which WORK NOTED
M RB
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
bal co
plated In six m ths.) CTIO
3 ATU (OWNE ENT) DJATESIGNED INSPECTION
DEPARTMENT
7 0 CITY OF
CITY OF
EDMONDS
NOTE: lApplicant Subject to Plan Check Fee PR 0-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalkso driverwaYss
marqueos, eta.) win require separate permission.
tZZ
119
[:] YEI; 13 NO
Fee
APPLICATION APPROVAL
This application Is not a perrnit 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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