740477.pdfBUILDING DEPARTMENT Applicant Fill
ZONr E
PERMIT APPLICATION Inside Heavy LinesJOB
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NAME (OR NAME OF BUIIINEBe7 G'�' -`// C, r L e
L R I
LOT
a MAILING ADDREBe
/O 2 �f !��l�L E�
PERM
CITY'
�D�oNDs
LEPHONE NUMBER
�775�-2901
ACTU
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PERMIT
NUMBER
YES [] NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
MISTING STREET R/W .........._ DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
N
-/L/ I YES 0 NO
RESIDENTIAL ❑ GAB ❑ YES U -Na I �J/
❑ NF.iV LINE PLANCHECKEDDY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL 0 SIGN ARKS/ -
El OF EDMONDS. LOCAL SALES TAX
nnn�� SHOULD BE CODED 31.04.
DEMOLISH ❑ RETAINING /'
ALTER ❑ ORCAVA FILLE ❑ PENCE
..........Ft.)
REPAIR ❑ IN PHONE POOL
NUMBER OF STORIES ""E" OF
DWELLING
2
UNITS
NATURES OF WORK TO BE DONE r�r� ` Valuation Fee Receipt Ne
f1i��yy +{J 0e cf 10dA*4DpiN4 DOz.� Plan Cheek Na .....................
'o k uD1n/4
&PMTfo ,Q / rC[w�
,ps (e5 /V OF BUILDING
PROPOSED USE v7
PdRcµsroxndfE,atl �lw; D6Lic qg0✓E PLUMBING
O PLOT PLAN (Ind dIBL.d�((IS ppIHmg Blreete) HEAT t& GAS LINE
��—� RdpO yO•RGN N� �K FENCE
SIGN
T RETAINING WALL
I SWIMMING POOL
�• • DEMOLITION
II M PRE -MOVE INSPECTION
(O� ♦ s-�+r-�/�G �' EXCAVATION OR FILL
—Bi �i34 --
� �Irye TOTAL AMOUNT DUE Q
I hereby acknowledge that I have rend this appllenllon; that the in-
formation given Is correct; and that I ato the owner, or the duly author.
Ired ngant of the owner. I agree to comply with ally and elate Inwe rebv- ATTENTION APPLICATION APPROVAL
telling aonetruclion; and In doing the work authorleld thereby, no person
11111 be employed In violation of the Labor Code of the State of Washington T1118 PERMIT This application is not a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep -
THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which ONLY OTE ut and fees are aid, and receipt is ac-
shall
be completed In ninety days; MOVED -IN BUILDINGS shall be emn. WORK NOTED y: P P
pieted In six months.) lino dged in apace provided.
28ILL11, OR AGENT) DATE SIGNEDINSPECTION ME B10NATURE
+7 DEPARTMENT
CITY OF
EDMONDB /DAWN
NOTE: Applicant Subject to Plan Check Fee 7 7 v
This Permit r work In be dou n private property ONLY. 775-2$48
Any Conelruellanlan the publle domain (earl". eideaalke, driveways,
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