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{ POSTED ON KROLL MAP NO.: PERMIT `
BUILDING DEPARTMENT Applicant Fill I NUMBER
PERMIT APPLICATION Inside Heavy Lines JOB ADDRESS
- I NAME (OR NAME OF BUSINESS) 7 %q
TELEPHONE NU1
N/rme!�
3SS
or
❑ NEW
ADD
El ALTER
❑ REPAIR
15
RESIDENTIAL
NON-RESIDENTIAL
❑
GAS
LINE
SIGN
NINE
RETAINING
PENCE x.......... Ft.)
SWIM
POOL
❑
❑
❑
O
DEMOLISH
ORCFILL E
PRE -MOVE
INSP.
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-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and to 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.
nph. Permit Limit One Year (Except DEMOLITIONS which
completed In Wnety days; MOVED -IN SDILDINGB Shall be com-
n nix months.)
�7
Applicant Subject to Plan 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.
O f
.CANT SITE `
YES NO
,RIANCE NUMBER
i
i
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. _ -- ............FT. O
REMARKS
IZO W
VERIFIED BY
YES NO
YES E3 NO
1OUP
ri r' 1A1a8A v Cx THIS SITE IS LOCATED IN TI
CITY OF E:NONOS. LOCAL SF
REMARKS TAX SHCILILD 6E CODED 31.1
Valuation
Plan Check No...........
BUILDING
PLUMBING
HEAT A GAB LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
J�
No.
T DUE
I
I
01
/ Z) 7�
ION
APPLICATION APPROVAL
MIT
This application is not a permit until
ZES
signed by the Building Official or his Dep-
rAUTHORIZES
ILE
TED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
ION
DIRE OR'B Bi ,p.TU
ENT
OF
'�'j�(J
DATE
FP7
EDMONDS
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