710056.pdfBUILDING DEPARTMENT
Applicant Fill
.,
PERMIT APPLICATION
Inside Heavy Lines
NAME
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W&IL&INU ADDRESS
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TELEPHONE NUMBER
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NAME
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ADDRESS
CITY
TELEPHONE NUMBER
NAME '
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ADDRESS
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TELEPHONE
CITY
NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal D crlp�tlon of Property (Show Below or Attach Four Copies)
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RESIDENTIAL GAS
NEW LINE
NON-RESIDENTIAL ❑ SIGN
ElADD
RETAINING
DEMOLISH WALL
ALTER AVATE CE
El ORCFILL ❑ (EN
..x.......... Ft.)
PRE -MOVE POOL
REPAIR
INSP.
r
DWELLING
UNITS
NATURE OF WORK TO BE DONE
/11JL__7 W � A-)p46-t1f___
PROPOSED USE -- ---_-- —_--
z'To,C lg ae of C19R
Ci PLOT PLAN (Indicate Building setbacks, abutting streets)
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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-
lzed 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-
pleted In six months.)
2,/1• 7
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (earbe, sidewalks, driveways,
marquees, etc.) will require separate permission.
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51 n) t'J. I a
okras x A/W
EXISTING STREET R/W .Ad...FT.
COMP. PLAN ST. R/W dl..Q..FT.
❑ YES
REMARKS
Plan Check No ....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
PERMIT
NUMBER 710056
04- .90.
ACK REAR YARD SETBACK
/ 51 rl;,-) -
VACANT SITE
I.1 YES VNO
DEFICIENCY THIS PROPERTY
..Q...FT.
0.2
AJl*
❑ YES ❑ NO
Valuation 1 Fee
No.
wMOUNT DDEIITTENTION
APPLICATION APPROVAL
rTMAL
HIS PERMIT
This application is not a permit until
UTHORIZES
ONLY TILL"ogs
signed by the Building Official or his Dep-
NOTED
uty; and fees are paid, and receipt is ac-
lulowledged in space provided.
INSPECTION DIRECTOR'S IGNAT
DEPARTMENT
CITY OF
EDMONDS
PR 6-1101
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