710465.pdf<, BUILDING DEPARTMENT I Applicant Fill
PERMIT APPLICATION
Insido Heavy Lines
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NAME (OR NAME OF BUSINESS)
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MAILING ADDRESS
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CITY
L 7 r L - Vv ,V t I TEV/ ' e03 3 837
Legal Description of Property (Show Below or Attach Four copies)
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❑ NEW
RESIDENTIAL
❑.
AS
LINE
❑
NON-RESIDENTIAL
❑
SIGN
ADD
ElDEMOLISH
DEMOLISH
WALL
❑ ALTER
❑
OR°FILL E
FENCE Ft.)
ElREPAIR
❑
IN P.
O
8P OL
(UMBER OF BTOItiES
NUMBER OF
DWELLING
/
UNITS
PATURE OF WORK T
4 D D tT' a
BE DONE
.pia IJ a t
3 C-0 2rn
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-
lating constructlon; 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 com.
pleted In six months.) _ _ A
NOTE: Applicant Subject to Plan Check Fee
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
DI'L MAP NO.: PERMIT
NUMBER
_ moo- o—
LOT AREA VACANT
❑ YES
E
r
ETPACH I I'
s
NO 0 1
dBER
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
1.:V,"5t1
❑ YES ❑ NO
❑ YES ❑ NO
THIS SITE IS LOCATED IN -
:ITY OF EDMONDS. LocAi s
TAX SHOULD BE CODED 31
l:
Valuation Fee Receipt No.
Plan Check No .....................
sir
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL Ism
TOTAL AMOUNT DUE a 0f 14s/
ATTENTION APPLICATIONAPPROVAL
THIS PERMIT This application is not a permit until
ONLY
TILE
icia
OSigned by the Building off Will or his Dep-
NLY
WORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION DlRyqroR.s ATU
DEPARTMENT
CITY OFF
EDMONDS DATE
PR 5-1107 9- / / / �-+ �•
FILE
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_ RECORD OF INSPECTIONS `
Date Passed k,
Foundation-
_ ,.
Plumbing (Partial)
(Rough)
Frame �-- S0111101110 KID'
' Furnace &Fuel Lines Final T— 0-7Z
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RECORD OF INSPE
CTIONS .
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�.d Date Passed
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1 Drainage
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Sewer.
Parking _
Landscaping '
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Fire Dept.
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