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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME
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A LI O ADDRESS
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CITY TELEPHONE NUMHi9R
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NAME ' ` �� Ar" r
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D ON KROLL MAP NO.: I PERMIT NUMBER 710031
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)DRESS
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SIDE YARD SETBACK
STREET SETBACK
REAR YAIDD�SETBACK
�G
//
USE ZONV
LOT AREA
VACANT SITE
�O
❑ YES
HEIGHT
I SUILDIN6 AREA
I VARIANCEAqUMBER
PLOT PLAN APPl•UV8{t/
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
ZONE I TYPE OF
RESIDENTIAL
El
GAS
❑ YES ❑ NO
NEWPLAN
NEW
CHECKED BY
❑ ADD
NON-RESIDENTIAL
❑
SIGN
rMARKB
El
WALL
R
DEMOLISH
EXCAVATE
FENC;
`
ALTER
El
On FILL
❑
Ft.)
ElREPAIREl
-MOVE
IN
a
..........
,
POOL
_'nr
6.
�UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
as ,,A•�—y^v vvt,.v.� Plan Check No.`.�................
z
BUILDING
y PROPOSED USE
aA PLVMBIN6
W
a PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT h 6A8 LIIQE
31
ti 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
lating construction; and in doing the wort[ authorized thereby, no person
will be employed in violation of the Labor Code of the Stale of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted in six months.)
31ONATUILE (OWNER Olt AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee PR s-uof
This Permit covers work to be done on private property ONLY.
Any construction on the public damala (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
i-L±
Valuation
❑ YES ❑ NO
Fee
APPLICATION APPROVAL
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.
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_. RECORD OF INSPECTIONS;
Date Passed
1 , :;Foundation
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_ Plumbing (Partial)
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_ ,Furnace & Fuel Lines
Finar if
RECORD..OF. INSPECTIONS
Date Passed
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Sewer
Parking ,.
Landscaping
Fire Dept:
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