700441.pdfBUILDING DEPARTMENT Applicant Fill
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1
PERMIT APPLICAI Inside 711c:avyLlnes
NAME
4MLAMWING JMODRESV�� I OLZ
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CITY ELEPHONE NUMBER
NAME
ADDRESS
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CITY TELEPHONE NUMBER
NAME
ILI
M ADDRESS
0
ITED ON KROLL MAP NO.: PERMIT
NUMBER 7
ADDRESS
I !) &? -2
91DE: IJARD SETBACK
STREET SETBACK
REAR YARD SETBACK
/.57 197;1--,
us
il
LOT AREA
YACANT SITE
0 YES
HEIGHT
T3UILDING AREA
VARIA
PLOT PLAN AI`VnUV�u
7ri'LEET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ IT.
REMARKS
Z
FA
U
A
14
CITY TELEPHONE NUMBER
I
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
— CHECKED BY
METER SIZE I SERVICE SIZE CLEARANCE ICHECKED BY
REMARKS
TYPE CONNECTION VERIFIED BY
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7—
PLRC. TEST PERMIT NUMBER
W
REMARKS
UD
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FIRE Z TYPE OF CONSTRUCTION STREET IMPROVED
(J YES E] NO
SP REQUIRED OCCUPANCY GROUP
29RESIDENTIAL
GAS
LINE
0 YES No
F] NEW
PLAN CHECKED BY
NON-RESIDEN'
SIGN
ElRETAINING
1:1
WALL
REMARKS
DEMOLISH
EXCAVATE
PENCE
VJ o 94 �Ql3jcc_vr TO 5rrc
ALTER
El OR FILL
( X Ft.)
REPAIR
PRE -MOVE
.......... ..........
SWIM
W6 M-no R fL- CZ 'DIE'
INSP.
POOL
L
U
DWELLING
UNITS
9-1le-5 No LqJ C t�5
I hereby acknowledge that I have read this applicatlon; that the In.
formation given Is correct; and that I arn 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.)
]IGNATUR , (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
ma.rqUeCR, etc.) will require separate permInslon.
Q.0RQLJA,WQG
Plan Check No
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Valuation
WIRM
Fee
TOTAL AMOUNT DUE .5-00
ATTENTION APPLICATION APPROVAL
No.
THIS PERMIT This application Is not a permit until
AUTHORIZES aigned by the Building Official or his Dep-
ONLY THE
WORK NOTED uty; and fees are paid, and receipt is ac-
I knowledged In space provided.
INSPECTION DIRECTOR,
DEPARTMENT
CITY OF
EDMONDS
PR 6-1107
FILE
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