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POSTED ON KROLL MAP NO.: PERMIT BUILDING DEPARTMENT Applicant Fill I NUMBER � 10293
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS nd 1
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CARD SETBACK STREET BETBA
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;ONE LOT AREA
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YARD s
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NO
I TELEPHONE NUMBER EXISTING STREET R/W ` A/'l...FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 36-37T. ..C!.... FT.
REMARKHDriveway slopes not to exceed those in-
dicated on Standard Drawing # 103
I CHECKED SY
TNI�EErHUNE NUMBER '�^'
7` % — / 7O� MET' SIZE SERVIC SIZE CLEARANCE CHECK BY
R O � � � CITY LICENSE NUMBER 2�t( I ���r•
REMARKS �1 UPC
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rty (Show Hol/o�gw or Attach Four Copies) 1 , /�1i�cyt %%nl f �/'� �t4Y1 1v (.fY
TYPE/ CONNECTION r (' M� I VEERI(,FNEIW BY
TYPE
GAS YES -A NO
RESIDENTIAL LINE PLAN CHECK D BY
NEW ❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD RETAINING REMARKS
DEMOLISH WALL �^
ALTER ❑ EXCAVATE FENCE
OR PILL (.......... x.......... Ft.)
REPAIR ❑ PRE -MOVE
P oL
VUMBER OF STORIES NUMBER OF �� *
DWELLING `vim
UNITS /
NATURE OF WORK TO BE DONE t
e
d� PROPOSED UBEe
aPLOTr PLAN (Indicate Building setbacks,
21
—
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation given In 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 DE51OLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.) ,
IIONATURE j(kWN)tR Olt AI XN) r / I DATE SIGNED
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NOTE: Applicant ft ject to Plan Check Fee
This Permit covers work to be done on prh•nte property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
7 �— /`/ 10 YES * NO
D I OCCUPANCY}, ROU
THIS SITE IS LOCATED IN THE
CITY OF EDNIONDS. LOCAL SALE
SHOULD BE CODED 31.04.
-Su E1ytV'ISka0
iT'S 1 N M O
Valuation
No.
TOTAL AMOUNT DUE
I
I /O/
.ATTENTION
APPLICATION APPROVAL
THIS PERAfIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR' 8RON OF
DEPARTMENT
�'
CITY OF
DATE ./
EDAIONDS
PR 0-1107
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RECORD OF INSPECTIONS
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Date Passed
FOUndation
(Partial)
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Plumbing (P. Rough)
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Furnace & Fuel Lines
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RECORD OF INSPECTIONS
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