710322.pdfBUILDING DEPARTMENT I AppucantFill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS 'f'�
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S/ o / y-oy .0 . S. ai
CITY TELEPHONE NUM:
NAME
p7 ADDRESS
/70 20 -Tc7/60 f kodci
15 CITY TELEPHONE NUM
,6-Cl Xt cdI d s, w &1 1778-.
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NO.: PERMIT % L
NUMBER 1
RD BEET13ACK I
STREET SETS 1CK
I REAR YARD SETJ
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5
ME
S ^' 1 I
LOT AREA
I VAO s T
SIT rl NO
EXISTING STREET R/W ../09,�t... FT. DEFICIENCY THIS THIS PROPERTY
COMP. PLAN ST. R/W .. .0Fr
. ..0....FT.
REMARKsDriveway slppes not to exceed those
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W ADDRESS
/ 7 n'T �o� ✓� cHEc BY
CITY TELEPHONE NUMBER
z / (�) j r 1) �j
v` n� / 7 f� / Q '2 S^ MEiTly� SIZE I SERV;Ct//E SIZE I CLEARANCE I CHEC BY
STATE LICENSE NUMBER'(j• CITY LICENSE NUMBER . 1 (4
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=?03 — B / - 6 7 I REMARKS eee���
Legal Description off P/ropert (Show Below or Attach Four Copies) UPC
PC 1 9 /v,
Sc L^ A / / oC7'1 4 e `t/O'yloi c-S TYPE CONNECTION 1— VERIFIED BYtt
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PERC. TEST I PERMIT NU B R �
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REMARKS m
1
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
❑
GAB YES ❑ NO
RESIDENTIAL LINE PLAN CHECKED BY THIS SITE IS LOCATED IN THE
NEW ❑NON-RESIDENTIAL ❑ SIGN
ADD ❑ WALRETAINING REMARKS
DEMOLISH . TAX SHOULD BE CODED 31.04.
ALTER � ORCFILL E ❑ PENCE x.......... Ft.)
REPAIR PRE -swim
O INSP. POOL
NUMBER OF STORIES
��� NUMBER OF
-N y Cl ft fx eR TS%LING
NATURE OF 1WORK TO BE DONE Valuation Fee Receipt No.
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/ o As.S % ftt Ov 71N Q Ca..) Is.� e-j t ly 'e Aj C. 'C-- Plan Check No ..................... 14
ZO BUILDING
PROPOSED USE
PLUMBING
FS t�d eAaC11,
QPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE21
Teo, (; A H-de./. e d )01,01r Pk,410 FENCE
SIGN
RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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i
TOTAL AMOUNT DUE
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 state laws regu-
ATTENTION
APPLICATION APPROVAL
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
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep-
'
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
Uty; and fees are paid, and receipt is ac-
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be wm.
knowledged in space provided.
i
pleted in six months.)
SIGNATURE (OWN R Oft AGENT) DATE 1GNED
INSPECTION
DIRECTO S10NA
.t`J-dZ 3C1 (
DEPARTMENT
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
—!
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
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marquees, etc.) will require separote permission.
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