710089.pdfF
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BUILDING DEPARTMENT
PERMIT APPLICATION
NAME teiR NAME 19F, RUG r 00",
Tt,) Oak T Z A�
a�d1 rTa REss
/V
Ri
Applicant Fill
Inside Heavy Lines
A/1Z, 2G74, 5-r6d -
TELE�P/HONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
aP *? - di -,422fvyl
or
® NEW
y`4� RESIDENTIAL
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
❑
El
WALL
DEMOLISH
PENCE
ALTER
❑
OROBI LTE
❑
Ft.)
REPAIR
PRE -MOVE
INSP.
.x..........
Swim
POOL
DWELLING
UNITS
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 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.)
10
-/0--?
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisslon.
C._
EXIS:'ING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
❑ YES
❑ NO
Plan Check No .....................
BUILDING
PLUMBING 3
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pa 6-1101
PERMIT
NUMBER
710089
//V,
❑ YES
❑ NO
DEFICIENCY THIS PROPERTY
❑ YES ❑ NC
Fee
l� l lso It? "I 3 I
i
APPLICATION APPROVAL
This application Is not a permit until i
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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