710064.pdf1
' BUILDING DEPARTMENT
PERMIT APPLICATION
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ON KROLL MAP NO.: I PERMIT }
NUMBER 710064
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ARD SETBACKI STREET SETBACK I REAR YARD SETBACK
❑ YES ❑ NO
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'NUMBER EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPER
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
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❑ RESIDENTIAL
❑
GAS ❑ YES
LINE PLAN
NEW
2--NON-RESIDENTIAL
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BION
❑
ADD
❑
❑
W`TLLININC
DEMOLISH
ALTER
❑
EXCAVATE
ORFILL
❑
(ENC x.......... Ft.)
❑
REPAIR
ElINSP.
PRE -MOVE
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POOL
NUMBER OF STORIES
NUMBER OF
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DWELLING
UNITS
TYPE OF
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❑ NO
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Plan Check No .....................
BUILDING
PLUMBING
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FENCE
SIGN
TRETAINING WALL
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1 SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thin application; that the In-
formation given to correct; and that I am the owner, or the duly author.
tzed 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
shalt be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six montlft�\
4 NOTE: Applicant Subject to Plan Check Fee
Tlds Permit covers work to be dono on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
Valuation I Fee
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or hie Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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