710255.pdfi
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POSTED ON KROLL MAP NO.: I PERMIT 1 10255
BUILDING DEPARTMENT NUMBER
+ I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
NAME (OR NAME Qie•cn•.' o? /(o/� — / .0.
/%Q/ADO AIDE YARD SETBACK STREET SETBACK I REAR YARD SETBACK
MAILING ADDRESS UAE 20Nfl LOT AREA Z
?//_ /, 79 VACANT BITE �.,
O CITY TELEPHONE NUMBE:f( �Al
I ❑ YES ❑ NO
` �ON ,Il �717 �� /O ,(� HEIGHT I BUILDING AREA l VARIANCE NUMBER
G % / PLOT PLAN APPROVED -
ADDRESS
F
STREET R/W
O EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
CITY TELEPHONE NUMBER
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COMP. PLAN ST. R/W ............FT. ............ IT. x
REMARKS ►�
NAME / 67
G ADDRESS L /j W
CHECKED BY
C CITY TELEPHONE NUMBER
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O LyN N/ `vr `� METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
r. V STATE LICENSE NUMBER CITY LICENSE NUMBER I I {�
/ n F
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION I VERIFIED BY
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Ei PEf2C. TEST I PERMIT NWSHEA [1�.4
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W - - REMARKS W
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.OW7 FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
❑YEA ❑NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS - ❑ YES ❑ NO
❑ NEW
RESIDENTIAL ❑ LINE. PLAN CHECKED BYI HIS SITE IS LOCATED IN THE
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NON-RESIDENTIALEl SIGN - CITY OF EDMONDS. LOCAL SAL
❑ ADD RETAINING REMARKS IAX SHOULD BE CODED 31.01.
ElDEMOLISH WAIT'
El ALTER M ORFILL
❑ FENCE
.x.......... Ft.)
❑ REPAIR PRE -SWIM
❑ IN pMOVF. ❑ POOL
NUMBER OF STORIES I NUMBER DWELLING
UNITS
F
NATURE OF WORK TO BE DONE Valuation I Fee I Receipt No,
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Plan Check No .....................
BUILDING
PRO'OSED USE
PLUMBING
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A
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT &GAB LINE
07
FENCE
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SIGN
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL ADIOUNT DUE
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I hereby acknowledge that I have rend this application; that the In-120-0
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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 elate laws tegu-
ATTENTION
APPLICATION APPROVAL
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lating construction; and 1n doing the work authorized thereby, no person
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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.
AUTHORIZES
signed by the Building Official or his Dep-
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NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ae-
-
shall be completed 1n nln ty days; IOVED-IN BUILDINGS shall be com.
lmowledged in space provided.
p 1n six m the.
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DST' 81ON D
INSPECTION
DEPARTMENT
DIR OR" Bi6NATU
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fi i" ,�Ir�LU�LG
CITY OF
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EDMONDS
DATE
NOTE: APPlicant Subject to Plan Check Fee
PR o-AAo'I
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separate permission.
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