700521.pdfZ
.DEPARTMENT
kPPLICATION
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Appileant Fill
Inside Heavy Lines
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700521
JOB ADDRE88
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VACANT SITE
YES C3 NO
VARIANCE NUMBEIt
EXISTINd STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............ FT. ............ I. T.
I
METER SIZE I SERVICE SIZE I CLEARANCE CHEC ED BY
M NUMI I vj, 4 25 la "
RESIDENTIAL
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R
GAS
LINE
El NEW
NON-RESIDENTIAL
—1
SIGN
0
RETAINING
DDEMOLISH
Ll
WALL
DALTER
EXCAVATE
FENCE
r—] OR FILL
El
( x Ft.)
.......... ..........
REPAIR
PRE -MOVE
El
swim
INSP.
POOL_
IUMBER OF STORIES NUMBER OF
DWELLING
UNITS
qATURE OF WORK TO BE DONE
V/ . /
'41 j" '1 �� .
[3 YES [3 NO
REMARKS
—
Plan Check No .....................
.e
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
,je
WALL
N
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 Is correct: and that I am the owner, or the duly author.
lzed 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.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
117TUIIE OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
76
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 6-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drlvew&Ys,
marque,es, etc.) will require separate permission.
Valuation
0 YES [3 NO
Fee
I
No.
�01111 04
APPLICATION APPROVAL
TWs application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
own
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RECORD OF INSPECTIONS
Date Passed
Foundation
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Final
Furna .5f
RECOMOF INSPECTIONS',
41'
4 lj:, Date: Passed
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