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- PORTED ON KROLL MAP NO,: NUMBIER 71056l 4 -
BUILDING DEPARTMENT Applicant
Inside Heavy Lines IOH ADDRESS
PERMIT APPLICATION ,
o 14 epf NA OR NAME OF HU INE88) `^, O N dY1 Q I
�/ BIDE YARD SETBACK 1ST E 81
HACK REAR YARD SETBACK
O
MAILING ADDRESS 1 r USE ZONE LOT VACANT SITE 1
l Pat IN
AREA r
C iY PHONE NOWn I I YES ❑ NO
75— WI It
HEIGHT BUILDING AREA VARIANCE NUMBER ,
NAME I I 1
PLOT PLAN APPROVED
1U.7 ADDRESS } -
. N STREET B/W 1
TELEPHONE NUMBER EXISTING STREET R/W ........... FIT, DEFICIENCY THIS PROPERTY 1
e CITY "
.. COMP. PLAN 8T. R/R' ............FT. ............ FT. 0 , ' ..
REMARKS
NAME -
Y
rr fod ADDRESS z
�� I CHECKED BY
CITY I TELEPHONE NUMBER
T '
p METER SIZE I SERVICE SIZE I CLEARANCE I CHECKED BY 1'
O STATE LICENSE NUMBER 1TY LICENSE NUMBER 0W7
REMARKS
�Legal Description or Property, (Show Below
�o�r Attach Four Copies)
IN
�/ f I LV TYPE CONNECTION VERIFIED BY AN
• F t U ���C -� PERC. TEST I PERMIT NUMBER
W4/�AV -i (0•o REMARKS m i
A]J _ A)A
(d FIRE TYPE OF CONSTRUCTION STREET IM`PR'OVED I
ri I I E] YES No r(
SPECIAL INBPEOTOR REQUIRED OCCUPANCY GROUP �J•••------ill---. ii ,
GAB ❑ YES NO
RESIDENTIAL ❑ LINE PLAN CHECKED BY '
NEW THIS SITE IS LOCATED IN THE ?
❑NON-RESIDENTIAL � SIGN CITY 69N;'le P!9e.—--?i+—aJ Ls i
ADD RETAINING REMARKS I
El DEMOLISH ❑ WALL TAX SHOULD 6E CODED 31s0k L,
FENCE
❑ ALTER ElORCFILL E ❑ (... ..... .3......... FIN)
❑ PRE -MOVE swim
IN P. ❑ POOL
REPAIR I;
NUMBER OF STORIES NUMBER OF
DWELLING
UNITSewl
I i
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
milC Plan Check No, .................
O BUILDING `�.
PROPOSED USE PLVMBIN6
Q PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT h GAS LINE ;..,
FFNCE �: , l
—7� 1
SIGN
dl.�)Q/b>b ��� 1�1�OsMSBr `�' RETAINING WALL
rvu� 77 Yet llliiilll 6/1 .NV I J
SWIMMING POOL
11
a wGkl I / E 't I! �t7.CIa� DEMOLITION
N' '
�k 1,1 PRE -MOVE INSPECTION
��Clkq a f'bwl EXCAVATION OR FILL —
I hereby acknowledge that I have read this application; that ills In-
formation given Is correct; and that I am the owner, or the duly author-
lred agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In dolor the work authorized thereby, no person
will be employed In vlolatlon of the Labor Code of the state of Washington
relating to WorkrI Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED-IIN BUILDINGS shall be com-
nleted an sax months.) �\ -
L; L.M"L)
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (cerbs, aldewalks, drlvewN4
ronnuees, etc.) will require separate Parnassian.
, 11
TOTAL AMOUNT DBE 3 2�. v5
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application i8 not a permit until 1 i
AUTHORIZES signed by the Building Official or his Dep-
WY THE
ORK NOTED uty; and fees are paid, and receipt is ac-
knowledged in apace provided.
i
INSPECTION ry
DIRECTO 6 U
DEPARTMENT
CITY OF
EDMONDS
PR d-1107
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