700423.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (03 NAMN
C
_ffA1LING ADDRESS
31 UJ BER
I TELEPHONE NUM
2
0
—A—I)DRES
-ULTY
Z
I-9—TATE I
Legal D,
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0 \AJ J\J C_ g-
or
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RESIDENTIAL
AS
GLINE
ElNEW
I
El
NON-RESIDENTIAL
SIGN
RETAINING
WALL
ALTER
El
DEMOLISH
EXCAVATE
OR FILL
El
FENCE
( x .......... Ft.)
..........
El REPAIR
F�
PRE -MOVE
INSP.
F-1
swim
POOL
DWELLING
UNITS
TO BE DqVE
Re, o�QF-C-K
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I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly author.
Ized agent of the owner. I agree to comply with city and state lawn 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 Wasbington
relating to Workmen -a 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.)
HIGNATURF (OWNER--O"GENT) DATE SIGNED
7c.
NOTE: Applicant Snbject to Plait Check Fee
This Permit coven work to be done on private Property ONLY.
Any construction on the public domain (curbs, Sidewalks, driveways,
ma.rquees, etc.) will require separate permission.
NO.: PERMIT
I NUMBER
) Itp — I I-) — do,,
RD SETBACK I STREWT SEEBACK
I "-) � 'n e— I /,I, -
STHELT AS/11
EXISTING STREET R/W ............ FT.
COMP. PLAN ST. R/W ............ FT.
ZONE
700423
REAR YARD BEW114CH
_A 134
FS I , ) j i
0 ).Zv
IT
VACANT SITE
0 YES N
0
V V
ARIANCE MBE R 9k
DEFICIENCY THIS PROPERTY
............ 1"r.
0 YES 0 NO
0 YES [] NO
REMARKS
Plan Check No .................
valuation
BUILDING 4_"_Q 020
'G a C) 0-2-
PLUMBING
BEAT & GAS ELINE
FENCE
SIGN
REMAINING WALL
SWIMMING POOL
DEMOLITION
PRE-N
EXCAVATION OR FILL
Z
No.
TOTAL AMOUNT DUE 3 0 C) fq-Zij
A= NTION APPLICATION APPROVAL
THIS PER511T This application is not a permit until
AUTHORIZES eigned by the Building official or his Dep-
ONLY THE
WORJI! NOTED uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
INSPECTION DIRECTOR
DEPARTMENT
CITY OF DATE
EDMONDS
Pit 6-1107 0
FILE
W 0
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