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BUILDING DEPARTMENT
Applicant FBI
PERMIT APPLICATION
Inside Heavy Lines ,oB
NAME (OR NAME OF BUSINESS)
BID
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MAILING ADDRESS
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CITY
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NAME
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ADDRESS
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TELEPHONE NX:
UMBER
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NAME in(
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CITY
TELEPHONE NUMBER
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Sea -t"T-(IC-1-
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STATE LICENSE NUMBER
I CITY LICENSE NUMBER
RE
Legal Description of Property (Show Below or Att ch Four Copies)
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® RESIDENTIAL LINE R
NEW
❑ NON-RESIDENTIAL ❑ SIGN
ADD ❑
❑ WAKING R
I..
DEMOLISH
ALTER ❑ EXCAVATE a FENCE _
OR FILL I .......... x.......... Ft.)
El REPAIR ❑ IRE -MOVE swim
El POOL _
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
I
_
NATURE OF WORK TO BE DONE
Ayaiiion� P
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E
(Hy
PROPOSED USE
F
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aPLOT
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PLAN (Indicate Building 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-
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 Stale of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOIITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
�.6
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, sldewalks, driveways,
marquees, etc.) will require separate permission.
TED ON KROLL MAP NO.:
PERMIT
ICJ IJ
NUMBER
I
ADDRESS
r a
f'd/bb3-(9
E YARD SETBACK
STREET SETBACK I
REAR YARD SETBACK
to
E ZONE+
LOT AREA
T BITE
.
I
I ❑ g NO
T PLAN APPROVED �.0, / .
EET R/W ���/
'.STIITG STREET R/ .......FT. DEFICIENCY TTHIS PROPERTY
DUP. PLAN 8T. R/W Y'(�••FT- ...t•-•'..FT•
dnRKSDriveway slopes not to exceed those
licated on Standard Dravring 1'103.
/d / C_
7
f / / I _/ /V I ❑ YES ❑ NO
DIAL INSPECTOR REQUIRED OCCUPANCY GROUP
YES [NO
.AN CHECKED BY
/ HIS SITE IS LOCI-.T D IN THE
r1TV n. rtl" •.n�mc, 1 r"'f AL CAI €S
i.MARK9
TAX SHOULD BE CODED 31.04.
,4G L Vorue Rm vac 1970
Valuation I Fee
Ian Check No.........
UILDING /
oQ Q. Q
106
LUMBING
[EAT & GAB LINE
`ENCE
IIGN
IETAINING WALL
SWIMMING POOL
DEMOLITION '
PRE -MOVE INSPECTION
EXCAVATION OR FILL
No.
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
ADTUORIZES
signed by the Building Official or his Dep-
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
Imowledged in space provided.
INSPECTION
DIRECTOR' SIGN 37
DEPARTMENT
f
CITY OF
/
DATE
Z !�
/
EDMONDS
PR 6-1107
FILE
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Foundation
Da te
P.assedr
Plumbing L, �
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Frarne
Furnace
nalal FLM' tines
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RECORD OF INSPECTIONS
Date Passed__