710023.pdfPOSTED ON KROLL MAP NO.: PERMIT ����
BUILDING DEPARTMENT Applicant Fill I NUMBER
'. PERNi1T APPLICATION Ineldn Ileavv blase ,in Ail„mcua )--
NAME ( )
i3 cc ivro nr (?o.lr, ,T- Co .
MAILI G ADDRESS
/CQ 0G - 69
CITY TELEPHONE NUMBER
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A�uDRESS —e
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CITY
STATE LICENSE Nt
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Legal Description of
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NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑ ADD
RETAINING
DEMOLISH
❑
PENCEx
ALTER
❑
OROPILLTE
Ft.)
REPAIR
❑
INS7P3fOVE
^❑
I I
..........
POOL
LL_JF
7UESBER OF BTORlES
NUMBER OF
DWELLING
UNITS
1 4'>� I I ❑ YES ❑ NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
YES i7 NO
—
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In-
formation given is correct; and that I am the owner, or the duly author-or-
tzed 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 Cods of the State of Washington
TIHB PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DE31OLITIONS which
ONLY TILE
WORK NOTED
shall be completed to ninety days; MOVED -IN BUILDINGS shall be com-
pleted to six months.)
(3pLAGENT
31012—m��
DATE 816NEU
INSPECTION
DEPARTMENT
x 7/
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, driveways,
marquees, etc.) will require separate permission.
❑ YES NO
Valuation I Fee
V_W. I 'If
s
F i
`
3
1
j
No.
APPLICATION APPROVAL --`I
This 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.
FILE
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- RECORD OF INSPECTIONS
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Furnace & Fuel Lines ?A —
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RECORD OF INSPECTIONS
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