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BUILDING DEPARTMENT Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
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NEW
RESIDENTIAL
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NON-RESIDENTIAL I
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SIGN
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RETAINING
WALL
DEMOLISH
EXCAVATE
PENCE
ALTER
El
OR FILL
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REPAIR
PRE -MOVE
........ . ..........
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INSP.
POOL
4UM13ER OF STORIES
NUMBER OF
DWELLING
UNITS
IFATURE OF WORK TO BE DONE
d" /I A"V,
STED ON KROLL MAr 14u-; PERMIT
/ / -S� C_ NUMBER
3 ADDRESS
)E SETBVK
UTREET SETBACK
REAkL
9707
LOT AREA
1 0 YES
10
EXISTING- STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ Fr. ............ IT.
FIRE ZONE I TYPE OF
SPECIAL INSPECTOR RE
0 YES 0 NO
STREET IMPROVED
E] YES 0 NO
All work must meet minimum requirements of
UBC 1967 and is subject to site inspecfiTon
for compliance.
C h e
Plan Check No .....................
r I n
D
BUILDING
B U I L
PLUMBING
P L U M IS
A T
HEAT & GAS LINE
H E
F N E
PENCE
E C
N
SIGN
I G
RETAINING WALL
.1
WIMMING POOL
S SW MM3
EMOLITION
D EMOLI
MC
PRE -MOVE INSPECTION
P
EXCAVATION OR FILL
XC VJ
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
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
relating to Workmen's Compensation Insurance.
AUTHOIUZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be e0m.
pleted In six months.)
IIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
Thla Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation I Fee
32111111111�1�
No.
1 5-. o a 1(.S7-74 el
APPLICATION APPROVAL
This application is not a perinit until
signed by the Building Official or Ills Dep-
uty; and fees are paid, and receipt Is ac-
Imowledged in space provided.
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FILE
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