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PORTED ON KROLL YAP NO.: PERMIT 710147
BUILDING DEPARTMENT Applicant Fill I NUMBER
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (" PT D11011d. ¢I �r 9 - r7 -- C -
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ADDS. 8— k /
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C TELEPHONE NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
L/y
or
NEW. �<
—knESIDENTIAL
GAS
LE
ADD
L
NON-RESIDENTIAL
❑
SIGN
❑
❑
WALL NINE
DEMOLISH
EXCAVATE
FENCE
ALTER
❑
OR FILL
El
(Ft.)
REPAIR
j�7
' `
PRE -MOVE
INSP.
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........ ..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.)
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the pub(lo domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
TYPE
❑ YES ❑ NO
I
Plan Check No............
BUILDING
PLUMBING a
BEAT A GAS LIN
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
YES ❑ NO.
DEFICIENCY TRIG PROPERTY
FNAU i_�N&k
Fee
No.
TOTAL AMOUNT DUE
l d r�fi'
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit Lentil
tzEs
ONLY THE signed by the Building Official or his Dep-
ONLY
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DEPARTMENT
OR'8 BfQ
EPARTMENT Jf
QITY OF
�` Z�P�I c, /�, ✓L
EDMONDS DATE
PR 6-1107
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RECORD -0E--INSPECTIONS
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