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POSTED ON KROLL 1
BUILDING. DEPARTMENT
Appli(antFill
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PERMIT APPLICATION
Inside Heavy Lines
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SIDE YARD SETBAC
NAME ( N9BB} r7�
Y��lFA-
MAILING/ADDRESS
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CITY
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TELEPHONE NUMBER
TELEPHONE
77$f SJ ' O
HEIGHT
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NAME -.y /�j
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PLAT PLAN APPROV
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ADDRESS
STREET a/W
G7
EXISTING STREET F
CITY
7 TELEPHONE NUMBER
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P,e g 6g w
COMP. PLAN ST. F
REMARKS
NAME
PERMIT
NUMBER 710
Driveway slopes not to ex
•0 ADDREBAA on Standard Drawing #103.
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F CI TELEPHONE NUMBER
E
MET SFZE BEII{
_ STATE LICENSE NUMBER CITY LICENSE NUMBER A
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REMARKS •I
Leegal Description of Property (ShowBelowor Attach Four copies)
07
• Or �•' / • �OD� • /' " -' — TYPE CONNECTION
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PERC. TEST
f, al REMARKS
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FIRE ZONE • I TYP
J9 NEW
ADD
ALTER
REPAIR
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RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
-MOVE
ElPRE
INSP.
DWELLING
UNITS
OAS
LINE
SIGN
RETAINING
WALL
❑FENCE
(........ ..x......... Ft. )
swim
POOL
Dry F
nFsi o FAICL
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.) A
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NOTE: Applicant Subject to Plan Check Pee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (eurbs, sidewalks, drbrowgs,
marquees, etc.) will require separate permission.
YES NO
11-70 COVE
Valuation
Plan Check No...
BUILDING
PLUMBING
HEAT h OAS LINE
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
NO
THIS PROPERTY
J
YES NO
Fee
TOTAL AMOUNT DUE I r /O Lf " I -O O[,
ATTENTION APPLICATION APPROVAL 7
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ONLY THE
WORH NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
Pn 0.1107
FILE
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