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BUILDING DEPARTMENT I ApplicantFlll
PERMIT APPLICATION Inside Heavy Lines
-Q_CC) 0-111-101-
11
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NO.: PERMIT
I NUMBER / I V r
USE ZONE I LOT AREA . I VACANT SITE
❑ YES ❑ NO
K
HEIGHT
HUILUINU AIL117A (
VAR+A1�lilL a�umnay.
•'��fJ
PLOT PLAN APPROVED
N O
G�aG_
STREET R/W
EXISTING STREET R/W
............FT.
DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W
............FT.
............FT.
1!54)(1T
nV2
FIRE ZOI�jC I TYPE OF rUCTION I STREET IM
SPECIAIAAILA! I INSPECTOR REQUIRED OCi-'UyANCY GROUP
❑ RESIDENTIAL GAB ❑ YES c] NO I Z
❑ NEW ❑ LINE PLAN CHECKED BY
❑® NON-RESIDENTIAL ❑ SIGN
ADD RETAINING REMARKS —TTT(S �i t'- uj 1
DEMOLISH ❑ WALL CITY C; n ��. 1 E
❑ E - )I`.OS. LOCAL SALES
ALTER EXCAVATE FENCE
❑ OR FILL ❑ (........ ..x.......... Ft.) X pe/1 1 •:� n i C /� �U 1.04..
❑ REPAIR ❑ PRE -MOVE swim
INSP. POOL
IUMBER OF STORIES NUMBER OF /� o
DWELLING
UNITS
PATURE OF WORK TO BE DONE Valuation Fee
Plan Check No ..................
jig
BUILDING
'ROPO
PLUMBING —
/'�a1 or a
?LOT PLAN (Ind( to Building setbacks, abutting streets) HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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 com-
pleted In six months.)
i
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.
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 THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
INSPECTION
DIRECTOR'S eIp U
DEPARTMENT
CITY OF
EDMONDS
PH 6-1107
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