710200.pdft
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1 B U I'L',h Applicant Fill
DEPARTMENT
PER�e i APPLICATION Inside heavy Lines
NAME (OR NAME OF BUSINESS)
Stanley Hegland
MAILING ADDRESS
8103 — 190th S. Y4.
G CITY TELEPHONE NUMBER
Edmonds, Wash. PR 8-8�.57
H
Day & Nite Plumbing & Heati.ng, Inc.
ej ADDRESS
P. 0. Box 216
CITY I TELEPHONE NUD1
Lynnwood, Wash. 778-1119
STATE LICENSE NUMBER CITY LICENSE NI
223 02 5867
. __....,......,..,,.... „r Prnnerty [dhow Below or Attach Four Cot
P NO.:
PERMIT
NUMBER
n r • --c N
EXISTING STREET R/W .......... .FT.
COMP. PLAN ST. R/W ............PT,
FIRE ZONE
A RESIDENTIAL
YES
LINE ❑PLAN
NEW
NON-RESIDENTIAL
SIGN
® ADD
❑
DEMOLISH
GAINING R]?.MA]
ALTER
❑
EXCAVATE
ORFILL
(�...NCE
..x........ Ft.)
REPAIR
n
PRE -MOVE
INSP.
j—'�
Lj
SWIM
POOL
DWELLING One
UNITB
and one basin
I hereby acknowledge that I have read this application; that the In-
formation given to correct; and that I am the owner, or the duly authar-
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 oom.
plated in six months.)
31ONATURE (OWNER OR AGENT) DATE. S GNE
L '
NOTE: Applicant Sub cec o Plan Check Fee
This Permit coven work to be done on prlrate ProPerty ONLY•
Any eonetractlon on the public domain (curbs, sidewalks, driveways,
marquees, eta.) win require separate Permission.
OF
NO
PlanCheck No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 10'9 00
r
REAR YARD SETBACK
O
VACANT SITE
L7 YES ❑ NO
VARIANCE NUMBER
$k
DEFICIENCY THIS PROPERTY
Valuation
YES ❑ NO
Fee
ATTENTION APPLICATION APPROVAL
THIS PERMIT TMia application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
° Y allL uty; and fees are paid, and receipt is ac-
WORK NOTED
llnowledged in space provided.
INSPECTION DIRE OR'S SI TU , 7 -..-./.___.i,,.^
DEPARTMENT,L
CITY OF
EDMONDS DATE
PR 0-1107 /
FILE
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RECORD OF INSPECTIONS 7.
Date Passed
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RECORD OF: INSPECTIONS
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