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POSTED
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADD
NAME �.(OR NAME OF BUSINESS)
/ BIDE TA
2 6 RE f
ON KROLL MAP NO.: I PERMIT 710283
REDS
/
RD SETBACK( STREET SETBACK I REAR YARD SETBACK
t7
f3 T f at!'— Ci n / � USE ZONE LOT AREA VACANT SITE
i CIN O7 TELEPHONE NQUMB&ft 0s 6 I I ❑ YES ❑ NO
a O� H IGHT I SUILDIN6 AREA I VARIANCE NUMHH
♦Mal
M
ADDRESS
STREET B/W
EXISTING STREET R/W
COMP. PLAN ST. R
...».......FT. DEFICIENCY THIS PROPERTY
FT. ............FT.
•
-
+. .... '..
CITY
TELEPHONE NUMBER
REMARKS
f
s �+• ,
S
/
i l J
CHECKED BY
C
TELEPHONE NUMBER
I ! V, V
METER SIZE SERVICE
SIZE I CLEARANCE
CHECKED BY
8T E LIOENSE NUMBER
CITY LICENSE NUM ER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
BY
r
.
y
!
(VERIFIED
PERO. TEST
PERMIT NUMBER
eq7
I
GREMARKS
FIRE ZONE
TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED
GROUP
.
YES ❑
❑ NO
(OCCUPANCY
RESIDENTIAL ❑ GAS
❑ NEW LINE
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ ❑ WALL xa
DEMOLISH
❑ ALTER EXCAVATE FENCE
❑ OR FILL ❑ (........ ..x..........Ft.)
❑ REPAIR PRE -MOVE SWIM
❑ INSP. ❑ P OL
PLAN CHECKED BY
THIS SITE IS. LOCATED IN TH
CITY OF EDMO NOS, LOCAL SAl
REMwlufa
TAX SHOULD BE CODED 31.0
Ili
e 16 �, - "1
o as R
DWELLING
UNITS
z
C
i;4 CL/_a Z r 'r (-L(4�— «C =a C-- L
Plan Check No..... ...............
it •
BUILDING
PROPOSED USE
PLUMBING
Q
E
ti
PLOT PLAN (Indicate Building setbacks, abutting streets)
N
' I
HEAT & OAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
ation given is correct; and that I am the owner, or the duly author -
regu-
agent of the owner. I agree to comply with city and state laws sego-
ATTENTION
lating construction; and In doing the work authorised thereby, no person
e employed In violation of the Labor Code of the State of Washington
THIS PERMIT
ng to Workmen's Compensation Insurance.
AUTHORIZES
LIxed
E: Permit Limit One Year (Except DEMOLITIONS which
WORKONL NO ED
complete nett' days; MOVED -IN BUILDINGS shall be eom.
In six tha.)
TURE (OWN OR AGENT) DATE SIGN
INSPECTION
�j 7
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR M1107
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.
Valuation
Fee
APPLICATION APPROVAL
No.
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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