710570.pdfPOI
BUILDING DEPARTMENT
Applicant FBI
PERMIT APPLICATION
Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)
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TELEPHONE NUMBER
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ADDRESS
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NAME
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Description of Property (Show Below or Attach Copies)
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❑ NON-RESIDENTIAL ❑ SIGN
ADD KING
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❑�ALL
DEMOLISH
EXAVATEl
CFILL E
ALTER ❑ `ENCj
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REPAIR PRE -MOVE SWIM
❑ INSP. POOL
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NUMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
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NATURE OF WORK TO BE DONE
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PROPOSED USE
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aPLOT
Building
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PLAN (Indicate setbacks, abutting streets)
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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-
Ised agent of the owner. I agree to comply with city and state laws regu-
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
relating to Workman'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.)
NATURE (OWNER OR AGENT)
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DATE SIGNED
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NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
O. t PERMIT
NUMBER
REET SETBACK
E ZONE
?C_�
15 z
,CANT SITE %
YES ❑ NO S
�RIANCE NUMBER I F,
:ISTIN6 STREET R/W 9u,, ,btX-T. DEFICIENCY THIS PROPERTY
:OMP. PLAN ST. R/W40J&PCr. ....LO.FT.
'MARKS DriVCU ty J.opes not to e::ceed those
.ndicated on Standard Drgaini; if103.
SIZE I S / IZE I CLEARANCE I CHI Cl ED BY
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�4-; S972r//cam '[, 72&Qs/o Pam
IRE ZO I7 TYPE OF CONSTRUCTION I STREET IMPROVED
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❑ YES ❑ NO
PECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES )!�NO I I 5� /
LAN CHECKED BY
THIS SITE IS 1_00A7FID IN THE
EMARRS ewr I,- CA!
TAX S J 10ULD Ec CODEDSALES
31_(14.
vUv7icA- C, ! o 710 exo Stl,
'Ian Check No .....................
WILDING /
'LUMBING
IEAT do OAS LINE
PENCE
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
CITY OF
EDMONDS
PR d-1107
Ot
No.
1 [ 2&W,0010,f ri
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
FILE
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