740636.pdfCITY TELEPHONE NUMHEH
NAME
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O STATE LICENSE NUMBERI CITY LICENSE NUMBER
PLANNING DEPT, APPROVAL DATE,
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
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BUILDING DEPARTMENT
REMARKS
USE
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PERMIT 740636
NUM13ER
01
44,
NON-RESIDENTIAL
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PERMIT APPLICATION
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LEGAL LOT VARIANCE OR CONDITIONAL USE
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ADDRESS 0 YES NO PERMIT NUMBER
CITY TELEPHONE NUMHEH
NAME
U ADDRESS
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C CITY TELEPHONE NUMBER
.7e o S�a7f/e I Elul 7 7010
O STATE LICENSE NUMBERI CITY LICENSE NUMBER
PLANNING DEPT, APPROVAL DATE,
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
REMARKS
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PERC. TEST
PERMIT NUMBER
REMARKS
1
UCTION STREET IMPROVED
YES p NO
OCCUPANCY GROUP
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
0
Valuation
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SWIM
EXCAVATION OR FILL
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POOL
IUNBER OF STORIES
NUMBER OF
TOTAL AMOUNT DUE
/
DWELLING
formation given In correct; and that I sun the owner, or the duly author-
UNITS
Ired agent of the owner. I agree to comply with city and state lawn regu•
ATTENTION
UCTION STREET IMPROVED
YES p NO
OCCUPANCY GROUP
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
0
Valuation
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Plan Check No. ....•.... ... ..
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BUILDING
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PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
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WALL
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SWIMMING POOL
DEMOLITION
-
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In.
formation given In correct; and that I sun the owner, or the duly author-
Ired agent of the owner. I agree to comply with city and state lawn regu•
ATTENTION
APPLICATION APPROVAL
lating emuitructlon; and In doing the work authorised thereby, no person
wlll be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITION" which
ONLY THE
WONOTED
uty; and fees are paid, and receipt is ac -
,hall be completed In ninety tlays; MOVED -IN DOILDINOS shall be cam•
knoWledged in space provided.
pleted In six months.)
-SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DIRECTOR'S BIG" TDRE
DEPARTMENT
CITY OF
EDMONDB
DATE
!
NOTE: Applicant Subject to Plan Check Fee
ZI �(�^ %
775-2525
Thin I•ermlt r Yero work to be done on private Property ONLY.
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RECORD OF INSPECTIONS I
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Foundation
Plumbing (Partial)
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Furnace & Fuel Lines
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