710013.pdfPORTED ON MOLL BAP NO.: PERMIT
NUMH
BUILDING DEPARTMENT ApplloantFW 710013
PERMIT APPLICATION Inside Heavy I,inee JOB ADDR SS y{
BIDE BARD SETBACR STREET SETBACK REAR YARD BETHAOH
` Of/� DRESSB//
USE Z NE J —~— VACANT BITE '
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i C TELEPHONE NUBSEft �YEB i7 NO ) _
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HEIGHT I BUILDING AREA I VARIANCE NUMBER
NAME
�AM 14 TO PLOT PLAN APPROVED
ADDRESS.
STREET R/W 1
I�/j T/EPHONE ,I.%�!]JIi���E EXISTING STREET R/W 4� O..FT. DEFICIENCY THIS PROPERTY
COMP.PcITY
L� �'►� Ns, S Y / /V •, /\, V [. REMARKS LAN BT. R/W .W..l!....FT. ... Q.... FT. p
l'�sr1lv!ro, r `Y,, NAME Driveway slopes not to exceed those indicated
ADDRESS on Standard Drawing #103
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,� 61 CITY TELEPHONE NUMBER .
x �= ritsA�� !✓N METER SIZE I SERVICE SIZE I CLEARANCE I CHECIJEE4 BY
.; STATE LICENSE NUMBER CITY LICENSE NUMBER � ?.
REMARKS
' Legal Description of Props y (Show Below or Attach Your Copies)
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O� � L AbA * /% TYPE CONNECTION VERIFIED BY i
F PERC. TEST I PERMIT NUMBVRI
WREMARKS m
G .!
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!' W FiRffi ZONE (TYPE OF CONSTRUCTION STREET IMPROVED
ri I ❑ YES ❑ NO
�pp SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
f �,,�,y,,,// GAS
❑ YES ❑ NO
1��I NEW [Mi
BIDENTIAL LINE PLAN CHECKED HYEl
_-"�N-RESIDENTIAL ❑ SIGN
ADD � ❑ RETAINING REMARKS
1 DEMOLISH WALL i
f, ALTER EXCAVATE
FENCE !
OR FILL (........ ..x.......... Ft.)
ElPRE -MOVE swim
REPAIR El INSP. POOL
NUMBER OF STORIES I NUMBER OF '
DWELLING
UNITS
NATURE OF WORK TO H DONE Valuation Fee Receipt No. "
APlan Check No ..................... _
p BUILDING �� SD
PROPOSED UBE '
PLUMBING
O PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT d: GAS LINE
FENCE
SIGN
RETAINING 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-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
luting construction; and In doing the work authorized thereby, no person APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit tin .
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt Is ac- I
shall be completed In ninety days; MOVED -IN BUILDINGS shall be core- knowledged in space provided.
pleted In six months.)
INSPECTION
BIGNATU (OWNER OR AGENT) DAT SIGN D D TOR'B IONAT f i
� � DEPARTMENT
CITY OF Dw )
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR 6-1107
I This Permit coven work to be done on private property ONLY.
I Any construction on the public domain (curbs, sidewalks, driveways,rum
t marquees, etc.) will require separate permission.
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