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r ��. POSTED ON KIiOLL HAP .t
PERMIT' o
BUILDING •DEPARTMENT ApplleantFlll I ��� 71�3U�
PERMIT APPLICATION
Inside xeaty LlrteB
JOB ADDAE
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NAME (OR NAMffi OF DUBINffi88)
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PLOT PLAN APPROVED
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BTREET R/W
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+`��); l`�',,tifb���.U:?�� it ;5,� NEW ❑
�, M''f°t{k�}`i r��+;'� �"y ri'` � NON-RESIDENTIAL ❑ BION
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�� ��_'�• '.�❑ADD ❑ DEMOLISH � WALL NINE
wW���, � � pI,TEg ❑ EXCAVATE FENCE
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PRE -MOVE SWIM
t �� ^ .n�{ �_r I i� � REPAIR ❑ INBP. � POOL
§ J.r,x'` c '. r + " NUMBER OF STORIES NUMBER OF
�{.,W�t"lr �•" +' - I DWELLING
r � a-° UNITE
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NATURE.OF WORK TO SII D
S�,P�n�L� �f�si �"/�'�
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PROP08ED UBE
Ci PLOT PLAN (Indlcnte Dullding setbacks, abuttlng streets)
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I hereby acknowledge that I have read thin aDpllcatlon; that the In-
tormntlon given Ie correct; sad that I am the owner, or lbe duly author-
ized agent of the owner. I agree to comply wltit city and elate laws rogu-
lating rAaetrnetlon; and la doing the work authorized theroby, ao Dersoa
will be employed In Wolatloa of the Labor Code of the State of Waahlagton
relating to Workmen's Compeaeatlon Iaeuraace.
PIOTE: Permit Limit One Year (Except DEMOLITIONS which
ahatl be completed la ninety days; MOVED -IN BDII.DIN08 shall be wm-
pleted In elz moathn.)
NOTE: Applicant SuGject to Plan Cbeck Fee
Thle Permit coven work to bo done on private property ONLY.
An7 coaetracttoa on the pabdc domain (curbs, aldewdka, drivewa7a,
marquees, etc.) wdt repairs erparate Dermlaalon.
EXISTING BTREET R/W ............FT.
COMP. PLAN BT. R/W ............FT.
❑ YE6 ❑ No
Plea Check No .....................
BUH.DIN6
PLVMBIN6
HEAT � 6A8 LINE
FENCE
BION
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOIINT DIIE
ATTENTION
THIB PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
OITY OF
EDMONDS
Pa alloy
■ •
DEFIOIENCY THIB PROPERTY
❑ YEB ❑ No
THIS SITE IS LOCATED
TAX SHOULD BE CODED
Feo
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APPLICATION APPROVAL
ThiB application iB not a permit until
signed by the Building Official or hiti Dep-
uty; and feeB are paid, and receipt iB ac-
knowledged in space provided.
FILE
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POSTED
IMS n-.
' ' BUILDING DEPARTMENT
! Applicant Fill
`.~„ PERMIT APPLICATION Inside Heavy Lines JOB AD)
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z 'y'l try ! N ME (OR NAME F BUSINESS) 1
SIDE Y.
�37t ' - IMALLJNG ADDRESS .
yf'. ri /' USE zI
CITY TELEPHONE NUMBER-
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or
NEW
El RESIDENTIAL
GAS
LINE
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NON-RESIDENTIAL
81ax
ADD
RETAINING
❑ DEMOLISH
a
WALL
PENCE
ALTER
❑ ORCFILLTE
❑
Ft.)
REPAIR
PRE -MOVE
❑
...z..........
swim
INSP.
POOL
IUMBER OF STORIES NUMBER OF
- DWELLING
UNITS
:ATURE OF WORK TO BE DONE
% L / %
• t
e
t A ,
TROLL MAP NO.: P IT . •�
NV�IBER 710383 t .
T
EA VACANT BITE
I ❑ YES ❑ NO
vn ♦nRk I VARIANCE NUMBER "
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
DEFICIENCY THIS PROPERTY
tY
MBER
r
❑ YES ❑ NO
PLAN CHECKED BY
THIS SITE IS
Plan Check No ................. ...
BUILDING
PLUMBING
HEAT & GAS LINE
N
ISWIMMING
FENCE
SIGN
RETAINING WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read thto application; that the In-
formation given Is correct; and that I am the owner, or the duty author-
ized agent of the owner. I agree to comply with city and state 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
shall be completed In ninety days; MOVED -IN BUILDINGS shall be coin-
\ pleted In six months.)
ova-��� �►. � J- -7-
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (eurbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
PR t1-1107
❑ YES
PROVED
IN THE
31.04
sus
Receipt No.
y
I
APPLICATION APPROVAL
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.
its ,.vi L-Vn:LMQ
7/
INSPECTORr
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