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Applicant Fill
Inside Heavy Lines
-Voy
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0
0
.
❑
RESIDENTIAL
NEW ❑LINE
NON-RESIDENTIAL
❑ DEMOLISH
EXCAVATEEl
ALTER ❑ ORFILL
REPAIR PRE -MOVE
INSP.
❑
❑
CI
L AS
SIGN
RETAINING
WALL
FENCE
(........ ..z......... Ft.)
swim
POOL
-
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NA U E OF WORK TO BE DONE
d �TL o ti., —i a r-
O
P�oPos�EDC.a "� G d �
t V-
PLOT PLAN (Indicate Building
0
3
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-
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-
pletedAn_six months.)
NOTE: Applicant Subject to Flan Check Fee
This Permit coven work to be done nn private property ONLY.
Any construction on the publle domain (eurbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES ❑ NO
Plan Check No............
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER 710000
I '
❑ YES
❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NO
Valuation I Fee
TOTAL AMOUNT DUE I I rJ , O 0 L s T� /
ATTENTION
APPLICATION APPROVAL J
THIS PERMIT
Tina application is not a permit until
AUTHOONLY
signed by the Building Official or his Dep-
ONLY 1D:
THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in Space provided.
INSPECTION
•�OR'a
DIRE NATU !::... jr
DEPARTMEAT
, � .. : '....'.`
CITY OF
DATE
EDMONDS
PH 6-1107
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