710258.pdfPOSTED ON KROL MAP NO.; PERMIT } 10258
BUILDING DEPARTMENT ApplicantPTll I NUMBER
PERMIT APPLICATION Inside Heavy Linos .IOB ADDRESS � C
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STATE LICENSE NUMBER I CITY LICENI
Legal Description of Property (Show Below or Attach Fou
to
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RESIDENTIAL
❑
GAS
LINE
El NEW
IN
NON-RESIDENTIAL
D
SIGN
ADD
RETAINING
DEMOLISH
LiA
❑
EXCAVATE
PENCE
ALTER
❑
ORFILL
❑
xFt.)
..........
REPAIR
❑
PRE -MOVE❑
swim
iUMBER OF STORIES
NUMBER OF
DWELLING
I
UNITS
t
N
I
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 slate 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
ettafi' A completed in ninety days; MOVED -IN BUILDINGS shall be com.
lAetedjh six months.)
Applicant Subject to Plats Check Fee
This 1'etmlt covers work to be done on private property Orrt.x.
Any construction on the public domain (curbs, sldewalks, driveways,
marquees, etc.) will require separate permission.
13 YES E3 NO
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. P./W ............FT. ............FT. O
REMARKS
O
w
F
STREET IMPROVED
YES tj NO
0 YES 0 NO
PLAN CHECKED BY f f-11S Sit L 13 LOCATED IN THI
CITY OF EDiMONDS. LOCAL SAL
REMARKS I AX SHOULD BE CODED 31.01
Fee I Receipt No.
Plan Check No .....................
BUILDING
PLUMBING
HEAT A OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THUS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ORK 211E uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION I 1 _
DI C OR'S SI NQTU I i ,--�---
DEPARTMENT �.J� ,,
CITY OF
EDMONDS DATE t
_ PR 6-1107 6am+1 / — / / l l t
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