710444.pdfPOSTED ON
BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION Inside Heavy Lines JOB ADDREB
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"`i ple.L/C.E J7 S —
TELEPONE NUMBER
to
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or
NEW
RESIDENTIAL
❑
GAS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
RETAINING
WALL
DEMOLISH
ALTER
OROFILL E
❑
FENCE
Ft.)
A ..........
EJ REPAIR
❑
PRE -MOVE
INSP.
SWIM
POOL
DUMBER OF STORIES
I NUMBER OF
DWELLING
UNITS
I hereby acknowledge that I have read this appllcatiun; 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 In doing the work authorized thereby, no person
will be employed In v101atlon of the Labor Code of the State of Washington
relating to Workmea'■ Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
#hall be completed In ninety days; MOVED -IN BUELDINGS shall be com-
pleted In six months.)
$--i;� 4-7 /
NOTE: Applicant Subject to Plan Check Fee
Tbia Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate parmisaion.
LL MAP NO.:
SYO.4
EXISTING STREET R/W .... ....... FT.
COMP. PLAN ST. R/W ............FT.
PERMIT
NUMBER
Ud�'
710444 �
S
REAR YARD SETBACK
VACANT BITE .
❑ YES ❑ No
VARIANCE NUMBER - -
DEFICIENCY THIS PROPERTY I 1 1
Notify Water Dept to remove meter
I
1
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q
FIRE ZONE
TYPE OF CONSTRUCTION. STREET IMPROVED
I
❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED
GROUP
❑ YES ❑ NO
(OCCUPANCY
-
E
PLAN CHECKED BY
THIS SITE IS LOCATED IN T
CITY
REMARKS TAX SHOULD BE CODED 31.04.
Cap gewer at property line and ask Public
i
Works to inspect.
Valuation
Fee
Receipt No.
Plan Check No .... _.......... ....
{
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BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
'
DEMOLITION-
%
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1.-
I"...
.
I
PRE -MOVE INSPECTION
_
EXCAYATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
'
ONLY TILE
uty; and fees are paid, and receipt is ac-
WORE: NOTED
knowledged in space provided.
INSPECTION DIRECTOR' IONffAffidd
DEPARTMENT
CITY OF EDMONDSDATE
y o� b ^� I
PR 6.110T
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Building Permit Application I Ins le Ham,
NAME (OR NAME OF BUSINESS) /� l
MAILING ADDRESS
Flu
Lines
/nroira�f; wQrh I ��- 6� q-90 Z.
i
NAME
Ny 1
ADD 7; 7 rn,,�sce cS7��e
CITY d ` / ./9TELEPHONE NI
GJ.
NAME
AC
o� llzvo ,o IYk. 9t Pl >L
T
ac
nc tYES
ETERlredk
TER
r� ro a t?o,Y/I1 �'o�irs � jxa�e,
7ee-
zevoi off
NUMBER OF STORIES
NEW DEMOLISH
IV ADD
Ef ALTER RESIDENTIAL NUMBER OF
� DWELLING
I j'
I REPAIR I I NON-RESIDENTIAL I 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 constructicn; 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
PLOT
I
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FILE
2
YES
❑ NO
BUILDING
I
VALUATION
BUILDING PERMIT
2
FEE
PLUMBING
3
PERMIT FEE
HEAT & GAS LINE
4
PERMIT FEE
DEMOLITION
5
PERMIT FEE
0
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDbIOND$
PR 0-1107
..........
IBUILDING
PERMIT
NUMBER
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SET BACK REAR YARD /
�S � I �J
MAP NUMBER VACANT BITE ,!
YES 13NO yyyC
LOT AREA I VARIANCE NUMBER 1
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3COOnci or INSPECTIONS t `'
Date°'Passed
Foundation
Plumbing (partial)
(Gough)
Frame ',r
It1itFurnace &Fuel dines`�
r,
I1I
t
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Address.. daa...........�2.G...... �/, Lot ............... .. Blk ...... Add
......
•.;, � Lot frontage ....................................... Area./J.Q..,.�< ..1...4.............. Septic tankFG�S�•u�..c���..
r �
Bldg. setbacks — front :�................. r. side...1.P. �................ 1. side.... .. 7..:. � ........ rear..
.... ............. t
Owner..UU/..................................:................ Address. ........... � ... ......... Tel. No. .......0 1 6/�
7 ,
Builder..:.:............................................................. Address ......................... rt........ `. ....... Tel. No............. ..:...-
Plansby............................................................ Address................... .................:.... Tel. No.............. ........
Plumber:
Remarks.......................................................... ..................... .....
This permit covers work ''d'd'ii
p
Heat Cont
o:
.............Zn. PrIlm the
construe~ion olny
:.14.4u:Us t...�ide_::all:b , drit e7i'lys , marque2fdCt. t
n..... �Tm�SS2OT1 :..................... :.
ete.) will require serrate"p Sl
The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating;; this
work i
f
rt
Signed Owner/Agent.......... 2 ....................................... Address Date :i�a
PERM for the above work is hereby approved, subject to the above conditions, and to compliance with the ap• .
proved plans and specifications, and Building Department notations thereon. l ,
1r�.
3
3.0
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;' Valuatwn � .Q.Q i%. � .......................... Permit fee...��..!�.� .. ...._.... Reed. by..... � s
Building Department, By. ...........
r "ry""' '.....:. ................. Date....... ...._.
This Permit does not cover Plumbing, Sewer or Electrical installations. < t
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