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POSTED ON KROLL MAP NO.: �-�� -
. BUILDING DEPARTMENT APPAcant Fill I NUMBERR 7 I C)'*' } �
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PERMIT APPLICATION Inside Heavy Lines
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MAILING A-DDRESUJ
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C-iTTY-�� TELEPHONE NUMBER
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NAME
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CITY TELEPHONE NUMBER
14
g e oti.',It- 5_32-7
STATE, LICENSE NUMBER CITY LICENSE NUMBER
;203-01-'45
❑ NEW
® RESIDENTIAL
0
LINE
NON-RESIDENTIAL
❑
SIGN
ADD
❑
DEMOLISH
WALL
E
ALTER
OROFILL
ElFENC.x
Ft.)
REPAIR
❑
PRE -swill
INSP.
❑
..........
POOL
iUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
/
0
zI
°y Cad' po ✓? U tr 1 t
W I PROPOSED USE
a PLOT PLAN (Indicate Building setbacks, abutting streets)
Se cr i- r o c-ile d
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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 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 eom.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE 8IGNED
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, drlvewWs,
rn"auees, etc.) will require separate permission.
3 , -- SI4II
ID/ SETBACK STREET SETBACK REAR YARD SETBACK
IE LOT AREA �}VC/�ACANT SITE
F YES ❑ NO c
C I BUILDING AREA I VARIANCE NUMBER •W7
nkxvY.. ../ .•
EXISTING STREET R/W .5�117T. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ..........� ? T.
REMARKS Driveway slopes not to exceed those
indicated on Standard Drawing =l03.
QECTION
T&. (0=L �JPQ,
STREET
❑ YES
❑ YES r11�NO I J
PLAN CHECKED BY THIS SITE IS LO !1, IUD M 1'112
CITY OF EDMONDS. LOCAL SALES
REMARKS TAX SHOULD BE CODED 31.04.
ITgekoyt% ioskcrt o Q 4 71 o 5 -1
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Plan Check No .....................
BUILDING
PLUMBING
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
crrY OF
EDMONDS
PR d-1107
I
Fee Receipt No.
(o3q�
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APPLICATION APPROVAL
This application is not a permit until
eigned by the Building Official or I his Dep-
uty; and fees are paid, and receipt Is ac-
knowledged in space provided.
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