710114.pdfBUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME
ff,09/4l}/V L,
MAILING ADDRESS
V6/6 — /96
CITY TELEPHONE NUMBER
Epmo�vns I PA F -5-AlF 1
U
W
H
GO-
M ADDRESS
CITY
F
oZ
STATE LICENSE
or
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PV 6-& r V l w T-,CA C 7- S
RESIDENTIAL
GAS
❑ NEWFul
LINE
NON-RESIDENTIAL
SIGN
❑
ADD
❑
D
DEMOLISH
O
RETAINING
WALL
®
EXCAVATE
D
PENCE
ALTER
❑
ORFILL
❑
xFt.)
REPAIR
❑
INSP. MOVE
..........
Pwim
OOL
(UMBER OF STORIES
NUMBER OF
DWELLING
UNITS
t
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.)
47-,-I. tZ f ,.c�1" 1312410 7,
NOTE: Applicant Subject to Plan Check Fee
This I'ermlt covers work to be done on private Property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisslon.
PERMIT J I 0
NUMBER
IF.TBACK
n REET +iETBACK
REAR YARD SETBACK
�
as l�
1
�S h„i,,,
t,.,�-
LOT AREA
VACANT SITE
i] YES (NO
I BUILDING AREA
VARIANCE. UMBER
EXISTING STREET R/W ............FT
COMP. PLAN ST. R/W ............FT
r
E11
DEFICIENCY THIS PROPERTY
............FT.
N/a
m
W
m
__JJJ� I -f— I ❑ YES ]NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY^ GROUP
/Y
YES _1 NO 1 `f � /
Plan Check No ...................
BUILDING
PLUMBING
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
EDNIONDS
PR s-1107
Valuation
Fee
M
I �>• 0 0 I (S-96v1
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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