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POSTED ON RROI
BUILDING DEPARTMENT
Applicant FBI
PERMIT APPLICATION
Inside Heavy Lines
IOH ADDRESS
NAME
SIDE YARD SET]
MAILING ADDRESS
amain 76' w
Deffi _ZONE
-
TELEPHONE NUMBER
�CITY
�_Z)
HEIGHT
NAME
PLOT PLAN APPI
ADDRESS
STREET R/W
C
CITY TELEPHONE NUMBER EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
/
REMARKS
/
NAME
Ay
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CC
ADDRESS
U
Cl
TELEPHONE NUMBER
s1zH e
8
METER
STATE LICENSffi NUMBER
CITY LICENSE NUMBER
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REMA— RS
Legal Description' of Property (Show Below or Attach Four Copies)
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PERC. TEST
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REMARKS
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FIRE ZONE
SPECIAL INSPE
RESIDENTIAL
OAS
❑ LINE
❑ YES
NEW
PLAN CHECKEI
'
..
.
ADD
ALTER
REPAIR
❑
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
❑
❑
SIGN
RETAIM
WALL NINE
FENCE
(........ s_....... Ft.)
SWIM
POOL
NUMBER OF STORiEe
NUMBER OF
/
I 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.
tied agent of the owner. I agree to comply with city and state laws regu-
lating construction: and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington
relating to Workmea's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; OVED-IN 13UMDINUH shall be com-
pleted In six months.)
NOTE: AQQlicath Subject to Plats Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Ej NO
PNUMBER 710275
YES
DEFICIENCY THIS PROPERTY
561
YES NO
CITY OF EDMONDS. LOCAL SALES
REMARKS TAX SNUULU BE GODE973
Valuation I Fee Receipt No.
Plan Check No ..................... ....
BUILDING
PLUMBING
HEAT do GAS LINE Nil
FENCE
SIGN
RETAINING WALL _
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE 1 1 "� L
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES signed by the Building Official or his Dep-
ORK TILE ut and fees are paid and receipt is ac-
WORK NOTED y, ' p
knowledged in space provided.
INSPECTION DI TOR'8 S ATU/j I
DEPARTMENT
�6
CITY OF
EDMONDS DATE
PR 6.1107 tr=OO�i
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