710583.pdfBUILDING DEPARTMENT Applicant Fill
:`` PERMIT APPLICATION Insido Heavy Lines
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AP rvo.: PERMIT
NUMBER
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;AR YARD SETBACK
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.CANT SITE
YES NO
x
�RIANCE NUMBER
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EXISTING STREET R/W&410 .FT. DEFICIENCY THIS PROPERTY
COMP PLAN 8T R/W pt T. •••••D..FT.
REMARKsDriyellay slopes not to exceed those
indicated on Standard Drawing_i'103.
P
❑ YES ❑ NO
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RESIDENTIAL
\J TIAL
❑
GAS -
LINE
❑ YEB IQ�L10
PLAN CHECKE BY
THIS SITE IS LOC!J'_7 : !M THE
NEW
ElNON-RESIDENTIAL ❑
SIGN
❑ ADD
CITYREMARKS !`ITV (1G r-nn^^••���� ; ;- ���^ �Is�S
DEMOLISH
❑
WALL
TAX SHOULD BE CODED 31.04.
ALTER
❑
EXCAVATE
OR FILL
❑
FENCE
(xFt.)
.......... ..........
❑ REPAIR
n
PRE -MOVE
INBP,
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SWIM
POOL
DWELLING
UNITES 1
Fee
Plan Check No .....................
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BUILDING
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A
PROPOSED USE
PLUMBING
HEAT A GAS LINE
PLOT PLAN (Indicate Builditng setbacks,aabb�utting streets)
Ct. �q CA �J �
tRETAINING
N
ISWIMMING
FENCE
SIGN
WALL
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the in-
DUE
C!
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-ION
lating construction; and In doing the work authorized thereby, no person
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of WashingtonRMIT
This application 1s not a permit until
relating to Workmen's Compensation Insurance.
Permit Limit One Year (Except DEMOLITIONS whichOTED
Shall be completed in ninety days; MOVED -IN BUILDINGS shall be cum-lanowledged
rTOTAANT
IZES
ILENOTE:
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
in space provided.
pleted In six months.)81
TURE ( ER OR A NT) DAT SIGN DTIONDIRECTOR'
NOTE: Applicant Subject to Plan Check Fee
MENTOF
EDMONDS
PH 0-1107
NA
V
DATE
7 1
FILE
This Permit coven work to be done on private property ONLY.
Any construction on the public domalo (curbs, sidewalks, driveways,
marquees, etc.) wIU require separate permlss!on.
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:3OTE I a I rS�wFR-8,I-PAWIP
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INGRleASE._SLAGHTLY tit
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CIF. NtIEDED .: T� .SJ►�E 1 N O
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4A,It44t<- 14
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� I -
RECORD OF INS E_ OCTINS
Date Passed
17 _
Foundation , �3 ,)y,
Plumbing (Partial)
A (Rough)— !-1 r—
F Frame r 7 j 1✓' -
-✓J� p � Furnace &Fuel Line �
/ Final
RECORD OF INSPECIION sad
pates
Drainage _
sewer.
Landscaping.`