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BUILDING DEPARTMENT Applicant Fill ZONE NUMBETR 740382
PERMIT APPLICATION Ifteide Heavy Linetl nnRoaw /7,,,, //l
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0
V
cc
9
F
O
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FRONT HIDE REAR FRONT SIDE REAR
NON-RESIDENTIAL
DEMOLISH
E
❑
CA90
LINE
SIGN
RETAINING
WALT'
YES 0 NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
Of EDMONDS. LOCAL SALES TAX
REMARKS 1v� (SAH-(O�ULD 8E CCO7D'ED�3144.,
/-x'--` WOr—
i
II
i •�
REPAIR
LEGAL LOT VARIANCE. OR CONDITIONAL USE
ORCFILL
MOVE PN P.❑
(ENCx.......... Ft.)
SWI
POOL
YES � NO PERMIT NUMBER
'U➢IBER OP BTORI EB NUMIIER OF
PLANNING DEPT. APPROVAL DATE:
STREET R/W /
EXISTING STREET R/W .6.RFT. DEFICIENCY THIS PROPERTY
/
!•
COMP. PLAN ST. R/W ..!?:�..FT. ....O.FT.
W
I
REMARKS
ti
PLAN (Indicate Building setbacks, &butting street-)
BEAT A GAS LINE
O
Z
ra
'i
CHECKED BY
OA— v
SERVICE 81ZE CLEARANCE CHECK B� ,
7,
.T10 VERIFIED BY •�
PERMIT NUMBER �.
UTA,
TYPE OFCONSTRUCTION I OABT IMO OVOED j
❑RESIDENTIAL
NEW
❑ ADD
ALTER
NON-RESIDENTIAL
DEMOLISH
E
❑
CA90
LINE
SIGN
RETAINING
WALT'
YES 0 NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
Of EDMONDS. LOCAL SALES TAX
REMARKS 1v� (SAH-(O�ULD 8E CCO7D'ED�3144.,
/-x'--` WOr—
i
II
i •�
REPAIR
❑
ORCFILL
MOVE PN P.❑
(ENCx.......... Ft.)
SWI
POOL
,�.,At C
'U➢IBER OP BTORI EB NUMIIER OF
DWELLING
V
aPIAT
UNITS
PLAN (Indicate Building setbacks, &butting street-)
BEAT A GAS LINE
IATURE OF WORK TO BF. DONY1
Valuation
Fee Recelpt No.
Plan Check No .....................
/i
C.00 i` -i Lt. 5EC*T?'ac1{E0
BUILDING
l�
[o Liu
W PROPOSED USE
PLUMBING
V
aPIAT
PLAN (Indicate Building setbacks, &butting street-)
BEAT A GAS LINE
�SE� A'(Yac NG D�
FENCE
j
SIGN
�
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
-9X0*YRTIGIq_6R FILL
! p
TOTAL AMOUNT DUE
hereby acknowledge that I have read this application; that the In.
formaI ion given 1s correct; and that I am the owner, or the duly guthor-
Ized agent e[ the owner. I agree to comply with city and state laws raga-
ATTENTION
APPLICATION
Inting construction; and In doing the work authorized thereby, no person
APPROVAL
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
retail og to Workmen's Compensation Iuuranee.
AUTHORIZES
by the Building Official or his Dep-
I
NOTE: Permit Limit One Year (ExceDl DEDIOLITIONN which
ONLY THE
WORK NOTED
uty; and lees are paid, and receipt is ac -
shalt he completed In Neely days; MOVED -IN BUILDINGS shell be com.
knowledged In space provided.
.
pleted In six months.)
S16N !tE IOWNE OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S
N
DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Cheek Fee
EDMONDs
DATE
This Permit co— work to be done on prlrnle properly ONLY.
775-2525
Any cenetntelioa an the public AnmMn (eurltn, nldrn•nike, drlrew'nye,
rtnr••., rtr., „III rrynl •epurnle i,e• ,ni.�rinn.
FILE