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POSTED ON KROLL MAP NO.: PERMIT
BUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION Inside Heavy neB
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NAME (OR NAME OF BU/S ESS) _�
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SIDE A D B1VE�IT�BA�CIC> STREET SETBACK REAR YARD ETBACK
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TELEPHONE NUMBERr�
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HEIO T BUILDING AREA VARIANCE NUMBER
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PLAN APPROVED
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CITY TELEPHONE NUMBER+
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COMP. PLAN BT. R/R' .�!!...Fr. ...��...FT.
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REMARKS Driveway slopes not to e::coed those
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indicated on Standard Drawing
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METER SIZE I BERM SIZE CLEARANCE CHECK D BY
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GAS
RESIDENTIAL LINE
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NON-RESIDENTIAL ❑ gIGN
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ElALTER ❑ OREXCAVATE PENCE
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REPAIR p IN P. POOL
NUMBER OF 13TORIES I NUMBER OF
DWELLING /
UNITS
NATURE OF WORK TO BE DONE
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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 bo com-
pleted In six months.)
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 permisslon.
FIRE ZONID I 0TYPE OF Coryy:ittuC'1'ioN I�nr•eri' imresUvZu
r/JI((�f� ~ YES ❑ NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GRIP
❑ YES KNO I j^ I
PLAN CHECKED BY
THIS SITE. iS LAC.',TFO IN' THE
REMARKS G1 I YUi- �:.rI':'_;;>. .%, 1,L JP\
TAX SHOULD UL CODED 31.04.
I DC� T/CALL 710 -766*a,67
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Valuation Fee Recelnt No. I
Plan Check No .....................
BVILDINO
PLUMBING /-�
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HEAT & GAS LINE.
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TAL AMOUNT DUE I ("' —I / �3
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
DEPARTMENT
CITY OF
EDMONDS
PR 0-1107
FILE
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