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BUILDING DEPARTMENT I ApplicantFlll U�
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PERMIT APPLICATION Inside Heavy Linea JOB
ADDII
PERMIT
NUMBER
LO
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740629
CUA"
COVERAGE
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
CHECKED BY
((2.1Z:-_M10V�0
I / / l0 0'1
METER I
SER
CITY LICENSE NUM Eri
I ❑ YES [3 NO
I
REHABS
perly (Show Below or Attach Four Copies)
L 1
GS
❑ LIANE
TYPE CC
O �L
El
((2.1Z:-_M10V�0
QDT
FIRE TYPE OF CONSTRUCTION IMPROVED
I ❑ YES [3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
❑ RESIDENTIAL
GS
❑ LIANE
❑ YES 0 NO
I
El
PLAN CHECKED 13YNEW THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
F
OF EDMONDS. LOCAL SALES TAX
SIGN
SHOULD BE CODED 31.04.
ADD RETAINING
1IJy�'II DEMOLISH WALL
RE��aajjj/}/}/}'RRRxs a
FENCE
1 C• Tj GLS V v/
ALTER ❑ EXCAVATE
OR FILL (.........x..........Ft.)
PRE -MOVE swim
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;" \�flV 1,J� ��
REPAIR El INSPI. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK To BE DO,NEI
Valentina
Fee Receipt No
J��-" LC
Plan Check No............ _.......
2e s ion -mac- E
BUILDING
PROPOSED USE
PLUMBING
PLOT PLAN (Indicate RIUrI�I¢Ing setback., abutting streets)
HEAT A GAS LINE
FENCE
""��..�••-/r Jj�, //�
SIGN
_
//y
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
b Q
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
t O
formation given le correct; and that I are the o ner. or the duly
lzed egent of the owner. I agree to comply with city and .tate laws regu-
ATTENTION
APPLICATION APPROVAL
toting c...truction; and In doing the work authorized thereby, no penon
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a perinit until
relating to Workmen's Compeneauon Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shell be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six month..)
IION U E IOWN$Ij Oma= AG ) DATE SIGNED
INSPECTION
DIRECTOR'S N
yG� eJU�DEPARTMENT
' 7 7�
CITY OF
EDMONDS
DATE
NOTE: Applicant SuGject to Plan Check Fee
Q,
775-2525
1
This Permit coven work to be done on private property ONLY.
Any ennslrartlnt� nn ihr. Duhllc dmm�ln lenrbn, eldew'nik., drhroways,
FILE
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