710145.pdf.,
BUILDING DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
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CITY TELEPHONI
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STATE LICENSE NUMBER`^ CITY LICED
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P NO.i I NuM Ira 710145
K187ING STREET R/W ...»..»...FT.
COMP. PLAN ST. R/W ............PT.
♦AVM\� u.-w -
❑ YES ❑ NO
DEFICIENCY THIS PROPERTY
FIRE ZONE I TYPE OF CONSTRUCTION I STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP 1
OAS ❑ YES ❑ NO r.
/ NEW RESIDENTIAL ❑ LINE PLAN CHECKED BY
NON-RESIDENTIAL ❑ BION
ADD ❑ O RETAINING REMARKS '
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DEMOLISH WALL �\
ALTER EXCAVATE FENCE
El OR FILL El (........ ..x.»....... Ft.)
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PRE
REPAIR O INSP. ElPOOL J�V /
NUMBER OF STORIES NUMBER OF 1'
DWELLING
UNITS
N TIURE OF WORK TO BE DONE (\�� Valuation FeeReceipt No. ,
{ L Q_� Plan Check No .................
BUILDING
,
PROPOSED USE.
PLUMBING �
Q PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT h GAS LINE r
O
e FENCE _
1
SIGNi,
RETAINING WALL
1 SWIMMING POOL ?'
DEMOLITION
PRE -MOVE INSPECTION ,
1
EXCAVATION OR FILL 1
i'
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-
lzed 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 THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZER ONLY THE signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED uty; and fees are paid, and receipt is ac-
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com- knowledged in space provided.
pleled In six months.)
SIGNATURE (OWNEIJO A EN ) DATE 81GNED DEPAINSPRTMENT DIR OR'S SIGNATURE
CITY OF
EDMONDS D T
NOTE: Applicant Subject to Plan Check Fee PR g-uor
This Permit covers work to be done on private properly ONLY.
Any construction an the public domain (Curbs, sidewalks, driveways, FILE
marquees, etcJ will require separate Permlesion.
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