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740104.pdfcrop oyerkd In Vfolatlon of the Labor Code of the stale of Waehl.gton THIS PERMIT relating to women's compensation Insurance. This application is not a permit until AUTHORIZER ONLY THE NOTE: Permit Limit One Year Signed by the Building Official or his De p--•" ` (Except DEMOLITIONS which than be completed In tautly day ; MOVED -IN BUILDINGS shall be oom• WORK NOTED uty; and fees are paid, and receipt is ac- I- ..the.) knowledged in space provided. 1 ATU (OWNER OR NT) DATE 11 ONE INSPECTION I R' BION TURF r3 i 2 7 CITY OF tLy +; EDMONDB BUILDING DEPARTMENT USE 2ZONEfj PERMIT 740104 AppUcant FII PERMIT APPLICATION Inside Heavy Lines Al los B Any eanetructinn an the P.bi]e dome]. (curb., .Idewalk., driveway., r ,rvlVrre, rlr.) .111 rr,imr .--t. Verodeeao. FILE ADDRESS ^�- c�••U NAME (OR NAME OF BUSINESS) WALT LESTER INS. AGENCY PLAMS88I8LE r IATCQVERAOEe/ •vA4L 9 y MAILING ADDRESS COVERAGE + 1047 Puget Drive LE_H$I¢}IT /SP POBEDHEIGHT y O CITY TELEPHONrEyINUMBER UAL OT{AREYAdn T L DG. AREA 7qZ p Edmonds, WA. 98020 774- 1047 ? / NAME G i FtDB PROPOSED YARDS 11.1 IDF. REAR FRONT SIDE REAR owner M ADDRE88 LEG LOT VARIANCE OR CONDITIONAL USE 8 0 NO P RMIT NUMBER CITY TELEPHONE NUMBER "7W N6 D TRE /{V O NAME E%IBT O STREET R/W ............FT. DEFICIENCY THIS PROPERTY j owner COMP. PLAN ST. R/W ............FT. ............FT. W m REMARKS ADDRESS C , W U CHECKED BY W 4 CITY TELEPHONE NUMBER /Ir r����]] �7/ N V STATE LICENSE NUMBER CITY LICENSE NUMBER METER SIZE I SERVICE SIZE CLEARANCE ECKED BY ' I Dt Legal Deecrlptlan of ".Percy (Bhev, HaIOW or Attach Four Coplee) REMARKS /✓ �Z .' TYPE CONNECTION VERIFIED BY CIA, a PDRO. TEST PERDfIT -UMBEIDC n W O REMARKS � i I J O E ^I FIRE ZONE TYPE OF CONSTRUCTION STREEIDIPROVED I I ES ❑ NO SPECIAL INSPECTOR REQUIRED OCCUPANCY OROUP RESIDENTIAL El O GAS LINE YES C],/ L� 9 NEN PLAN CHECKED IIY THIS SITE IS LOCATED IN THE CITY NON-.EBIDENTIAL SIGN OF EDMONDS. LOCAL SALES TAX © ADD RETAINING El DEMOLISH WALL FEMARK9 cH0 I D B OD D it O¢ ® ALTER EXCAVALTE PENCEO // / p� ❑ FILE](..........x..........Fl.) l�i/...i!/A LL4 T/N JZ5OR REPAIR PRE -MOVE SWIM INSP. POOL ID t�Jf- L:J/114r/D G /T/ C�Oti cam'" l✓N /`'O NUDIDER OF STORIES NllMISER OF , DWELLING 0 I UNITS 0 NATURE OF -11K TO BE DONE e� Chanoe sign per attached diagram Valuation Fee IicceiPt No.Plan 4 Chetk N...................... (ttOI BUILDING a� PROP08ED UeE O PLUMBING PL�%OT�PLy tindicate Btaiding sett, eRs, abutting etMele) HEAT @ GAS LINE FENCE 1 SIGN a }- �v ' RETAINING WALL .•j i�(J N 1 SWIMMING POOL DEMOLITION PRE -MOVE INSPECTION EXCAVATION OR FILL TOTAL AMOUNT DUE , / •io Ir• ��� O Z hereby acknowledge that I have read title appllcation;that We In- formation given ie correct; and that I am the owner, or the duly author- Ized agent of the owner. I agree to comply with city and elate laws regu- feting conetructian; and 1.doing the work authorized thereby, no I,.rean •111 be ) ATTENTION APPLICATION APPROVAL crop oyerkd In Vfolatlon of the Labor Code of the stale of Waehl.gton THIS PERMIT relating to women's compensation Insurance. This application is not a permit until AUTHORIZER ONLY THE NOTE: Permit Limit One Year Signed by the Building Official or his De p--•" ` (Except DEMOLITIONS which than be completed In tautly day ; MOVED -IN BUILDINGS shall be oom• WORK NOTED uty; and fees are paid, and receipt is ac- I- ..the.) knowledged in space provided. 1 ATU (OWNER OR NT) DATE 11 ONE INSPECTION I R' BION TURF DEPARTMENT 2 7 CITY OF tLy EDMONDB DATE NOTE: Applicant Subject to Plan Check Fee This Permit covers work to be done on private property ONLY. Pn a-lla7 7� Any eanetructinn an the P.bi]e dome]. (curb., .Idewalk., driveway., r ,rvlVrre, rlr.) .111 rr,imr .--t. Verodeeao. FILE