710077.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME E6M'IHDaS'tJD^EII
-MAILING
ADDRESSCITY i
TELEPHONE NUMB..
, J c k &L 'S / a/
RE88
Legal Descr
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NEW
I I ADD
I I ALTER
REPAIR
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RESIDENTIAL
❑
OAS
LINE
NON-RESIDENTIAL
❑
SIGN
❑RETAINING
DEMOLISH
WALL
EXCAVATE
OR FILL
FENCE
(........ ac.......... Ft.)
I 1
PRE -MOVE
INSP.
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swim
POOL
NO.: PEE, 710077
❑ YES ❑ No
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
❑ YES ❑ NO
❑ YES ❑ NO
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DWELLING
UNITE
NATUR�E WORK TO BE DONE
Valuation Fee Receipt No.
/pOFQ
Plan Check No .....................
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BUILDING
PROPOSED USE
PLUMBING 3
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PLOT PLAN (Indlc¢te Building setbacks, abutting streets)
a
BEAT & 6A9 LI
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nFENCE
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SIGN
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RETAINING WALL
1
SWIMMING POOL
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DEMOLITION
i
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
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formation given in correct; and that I am the owner, or the duly author-
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Ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
APPLICATION APPROVAL
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
This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES
signed by the Building Official or his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORE: NOTED
and fees are aid and receipt is ac- i
uty� paid, p i
shall be completed in ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided
pleled In six months.)
SIGN U O. A T) DATE 36NED INSPECTION
D OR'8 sLI¢NATU
DEPARTMENT
C
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CITY OF
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EDMONDS
DAT ti --� -~
NOTE: Applicant Subject to Plan Check Fee
PR g-Slo't
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, eldewalks, drivewgh
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marquees, etc.) wlu require separate permlulon.
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