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BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
POSTED � LL MAP NO.: pggMlT
� S W I NUMBER %IOI I3
JOB ADDRESS P
9 '
NAME R /I.�
%1/�G'f L{ r i G e / 1 / / / �%
BIDE YARD SETBACK
�( �� I
STREET SETBACK
Y
a- O) {�.�./ -
REAR YARD BETBAC
y��
fl I •
E
MAILING ADDRESS
/ —? f f l •n e S�.
/ %
US/E/( �ZZONE /
( <) g / _
AAA 111000
LOT AREA
I I
VACANT SITE
❑ YES NO
G
CITY
-E mO h
TELEPHONE NUMBER
3 7 76 1
1
HEIGHT
I BUILDING AREA I
VARIANCE UMBER
ltyy
NAME
PLOT PLAN APPROVED
yUj
F
ADDRESS
'
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
CITY
TELEPHONE NUMBER
REMARKS
NAME
-r z. Oec es -a "el Qr^viG-e
01
ADDRESS
CHECKED BY
CITY
TELEPHONE NUMBER
METER SIZE I SERVICE SIZE I CLEARANCE
I CHECKED BY
STATE LICENSE
� NUMBER ,J
2 ZV/ .3 �l % 7
CITY LICENSE NUMBER
I
REMARKS
"A
Legal Description of Property (Show Below /or Attach Four Copies)
Vex-14 Ae:-6/t4 LJ / Z, r '1D,
TYPE CONNECTION
VERIFIED BY
Z
PERC. TEST
PERMIT NUMBER
W
REMARKS
re d� eeo e
�Paal-a�1 0 o Tb u or�i f'h
FIRE 4DNC I TYP�CON[STR�UCTION TREET JMPROV]
/ 'JIJ//' YES ❑ No
SPECIAL INSPECTOR REQUIRED OCCUPANC OUP
K/ / ❑ GAS ❑ YES *O�NO
RESIDENTIAL LINE PLAN CHECKS BY
NEW ❑ NON-RESIDENTIAL
BICN AZAJ
ADD RETAINING REMARKS
EXCAVATE
WALL ^� .4♦� /g". / EN 6� s
ALTER EXCAVATE FENCE /L/
O OR FILL (........ ..x.......... Ft.)
REPAIR O PRE - swim
IN SP. POOL
IUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
%�Glyld�P� 4,atngALP /h74U
Plan Check No .....................
Aetjrl° Lf7 t?/1 /`
BUILDING
PROPOSED USE
PLUMBING
a
m
O
n
PLOT PLAN (Indlcato Building setbacks, abutting streets)
tRETAINING
N
HEAT h 6A8 LINE
FENCE
SIGN
WALL
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 author-
ized agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
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
TINS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
ROTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be eom.
pleted In six months.)
IlO TURF (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
7�
r"' •
CITY OF
EDhIONDS
NOTE: Applicant Subject to Plan Check Fee
PH a-IIo7
This Permit corers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
No.
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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