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BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME
-MAILING ADDRESS
TMLE
PBON NUMBER
is
9
LE HoxE NUMBER
AA OW
RESIDENTIAL
OAS
LINE
NEW
777777"''"'''"'''""'''����``
ADD
Li
NON-RESIDENTIAL
❑
SIGN
AINING
❑
DEMOLISH
❑
WALL
ALTER
❑
EXCAVATE
ORFILL
❑
FENCE
.......... Ft.)
,..x
REPAIR
❑
PRE -swim
INSP.
❑
POOL
DWELLING
UNITS
Q 0
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 Workman's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewa7s,
marquees, etc.) will require separate permission.
PERMIT
NUMBER
i
Q"''a p, Sao
II
710038
❑ YES C3 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............ IT.
YES ❑ NO
REMARKS r\
Plan Check No.......
BUILDING
PLUMBING 3
HEAT do OAS LAN
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
13 YES ❑ NO
Valuation I Fee Receipt No. I
TOTAL AMOpNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
Ti11,s application is not it permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
D OR'S Sl(1NATU
DEPARTMENT
///� '
CITY OF
DAT
EDMONDS
1
PR 6-1107
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< RECORD 0 Ai
INSPECTIONS
Date. Passed'
45
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