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UILDING DEPARTMENT I AppucantFlll
PERMIT APPLICATION Inside Heavy Lines
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PERMIT
NUMBER
MAILING ADD SB 1� I T
USE ZONE LOT A ••/ AOANT BITE
C CITY TELEPHONE NUMJIRR� 51 J I I YES ❑ NO
HEIGHT UILDINO AREA VARIANCE N MBER
NAME j9m: GfzOpVEDPLOT PLAN APPROAD RES
e STREET a/W
CITY ITZLEPHONE NURSER EXISTING STREET R/W .IS%, DEFICIENCY THIS PROPERTY
COMP, PLAN ST, R ...n..FT,
REMARKS
NAME
8er' r Stu C e, L (�
Ot QADDRESS /
P L . s, clJ •
' I CITY TELEPHONE NUMBER
r lyf� Q �,(�
rdvn o ✓1..d: s I / , /J _/ I METER SIZE SEAVSCID SIZE CLEARANCE C17Y
STATE LICENSE NUMBER / CITY CENBE "UMBER
HEhE&RX3
Legal Description of Property (Show BeloworAttach Four Copies)
1\ es+� J Q C t O 4—. O
.., TYPE CONNECTION VERIF
YP}L
4+ 131 c UhrsPpHER
REMARKS T2 i ` V li
wLue: E
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FIRE ZOW TYPE OF CONSTRUCTIOS( I STREET IMPROVED
❑ YES O
SPECIAL INSPECTOR REQVIRED OCCUPANCY qROUP
RESIDENTIAL ❑ GAS ❑ YES )(NO
® NEW
LINE PLAN CHECKED BY
❑ NON-RESIDENTIAL ❑ SIGN
❑ ADD RETAINING REMARKS T--1419 SIT-9 19 LGGAT-9P IN TWE
WALL t: �� r, t . c ..
❑ affiMOIasH ❑ CITY Or ,;'tCN.�,,. Lf:..1L SALES
❑ ALTER EXCAVATE PENCE
ElTA,i-�Iie�e� �� �T`�y:43 Q4-r—
PRE-MOVE swim
OR PILL ElC.........x..........Ft.)
❑ REPAIR ❑ INSP,❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
I I UNITS l
••�•�•" �` W......' "l„AIAS Valuation Fee
Plan Check No...„..._..__.....
c
G BUILDING 38Oo0. CIO
PROPOSED USE dS
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAB LINE �t O O
al
n FENCE
SIGN
RETAINING WALL
N
I SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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-
lred agent of the owner. I agree to comply with city and state laws regu- ATTENTION
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance, AUTHORIZES
Y THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WOK NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six mouths.)
]IONATURE (OWNER OR AGENT) DATE SIGNED INSPECTION
DEPARTMENT
�`' 6• CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
P8 h1107
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, eldewaWs, driveways,
marquees, etc.) wW require separate permisslon.
/S74C) 10 Y-h _
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.
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