710061.pdfU
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME ((#YfdYcLii /
MAILING ADDRESS
or
POSTED ON KROLL slAr NO.:
PERMIT
NUMBER
71006f'
Applicant Fill
O W
O 3
Ilt'Id Iicnvy Lines
JOB AyDyD/HEdB/�
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O K�
SIDE YARD SETBACK STREET SETBACK
RL,AR YARD SETBACK
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itD' rr)�t. a s'
rn
01g )rho./
USE ZONE LOT AREA
VACANT SITE
.EPHONE NUMBISR
I\ I
I•tn�l a�
YES NO
I
NUMBER
HEIGHT I BUILDING
AREA
I VARIANCE
CL4
NEW
IDENTIAL
❑
GAS
INE
n[NEO'N
-RESIDENTIAL
SIGN
ADD
NINC
1-1DEMOLISH
El
WALL
❑
EXCAVATE
FENCE
ALTER
❑
ORFILL
❑
XFt.)
REPAIR
0
INSP. PRE-3fOVE
O
..........
PWIM
OOL
(UMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
?ATURE OF WORK TO BE PONE ,0
EXISTING STREET R/W
COMP. PLAN ST. R/W
it
TYPE OF CONSTRUCTION
M
THIS PROPERTY I+
gr I I YES D�NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP -�`
YES ZNO I =42r /
/DENT cA G 70 70 6 07
tiU
Plan Check No .....................
BUILDING
PLUMBING
ling streets)
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
I
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 aL aor-
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 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.)
J�NAT�UJRE_ (O V R OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit coven work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Valuation Fee
Re
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e
9Ge ig-o I 516Z
APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE