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CITY LICENSE NUMBER
Below or Attach Four Copies)
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POSTED ON KROLL MAP NE
B U I LD ING DEPARTMENT
Applicant Fill
JOB ADDRESS
PERMIT APPLICATION
Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
06�� 6—
SIDE YARD SETBACK STk
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MAILING ADDRESS
41
USE ZONE
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CITY TE"MONE NUMBER
-7 Lin 1)kl
HEIGHT
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ADDRESS
_,311 /,V.
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STATE LICENSE NUMBE:
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&M_ 77P�QQ)�S O�E SN640MIS" (?6_9
AS
NEW anESIDENTIAL m GINE
LQ.NO p SIGN
ADD RETAINING
1:1 DEMOLISH El WALL
F] ALTER EXCAVATE PENCE
EJ OR FILL 0 ( ........ . X .......... Ft.)
REPAIR PRE -MOVE swim
INSP. POOL
;UMBER OF STORIES I NUMBER OF
DWELLING
UNITS
qA URE OF WORK TO BE DONE
PERMIT
NUMBER
, 7 00146
[3 YES 13 NO
A� Z kotVOL g =S & f �-d I
STREET R/W
EXISTING STREET 9/W ............ FT. 41 DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ . FT.
0 YES [] NO
PlanCheck No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING 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 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- ATTENTION
latlog 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
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shell be rorn.
pleted In six months.)
3IQN0LTURE tOWNER 01�,AGEN�T) ATE SIGNED INSPECTION
DEPARTMENT
'26 CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee PR 0-1107
This ]Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marqueesp etcj will require separate permission,
0 YES 0 NO
Fee
No.
re�-�C,jWd
APPLICATION APPROVAL
This application is not a pernift until
eigned by the Building Off Icial. or his Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
FILE
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RECORD OF INSPECTIONS
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