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USE PERMIT 0643
BUILDING DEPARTMENT
AppLcant FW ZONE NUMBER
PERMIT APPLICATION Inside Heavy Linea IGS
ADDRESS
I NAME (OR NAME OF BUSINESS)
LEGAL LOT VARIANCE OR CONDITIONAL USE
o YES [j NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
STREET R/W C
EXISTING STREET R/W ............Fr. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............Fr. ............FT. G7
REMARKS
d
N
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n
PERC. TESTPERMIT
REMARKS
NUMBER
O
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
/
BUILDING
I
Q YES [] NO
Y PROPb88D USE
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
PLUMHINO
RESIDENTIAL
GAS
❑ YES 0 NO
❑ NEW
❑
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
HEAT & GAS LINE
®
NON-REHIDENTIAL
El
SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
A
O
PENCE
SHOULD BE CODED 3104
ElDEMOLISH
RETAINING
WALL
REMARKS
RETAINING WALL
ALTER
CFILLAVA E
[jFE
NCz
❑
OR
SWIMMING POOL
.......... Fl.)
REPAIR
DEMOLITION
PRE -MOVE
INSP.
SWIM
POOL
PRE -MOVE INSPECTION
N U,]➢ER OF BTORI ES
EXCAVATION OR FILL
i
DWELLINGF
I
TOTAL AMOUNT DUE
I hereby acknowledge that i pave read this application; that the
UNITS
Plan Cheek No .....................
/
BUILDING
Y PROPb88D USE
PLUMHINO
PLOT PLAN (Indicate Building eetbaeks, abutting street.)
HEAT & GAS LINE
17f ^
A
O
PENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
+
I
PRE -MOVE INSPECTION
EXCAVATION OR FILL
i
TOTAL AMOUNT DUE
I hereby acknowledge that i pave read this application; that the
In.
formation given Ie correct; and that I a n the owner, or the duly author -
I tr the owner. I agree to comply with city and state ]nwe ergo•
Toting doing
ATTENTION
APPLICATION APPROVAL
ati g co
conntructlon; and to the work authorized thereby, no person
eby,
I
will be employed In violation of the Labor Code of the slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Ineuranes.
AUTHORIZES
signed by the BuildingOfficial Or his De
Dep
Permit Limit One Year (Except DEMOLITIONS which
ONLY TUE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
shallbe completed In ninety days; MOVED -IN BUILDINGS shall be com-
llnowledged in apace provided.
I
pietcd In elx month,.)
SIGNATURE (OWNER OR AGENT)
DATE STONED
INSPECTION
DS OR's RlONATU
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DEPARTMENT
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/S h7
F
CITY OF
EDhfON
DATE
NOTE: Applicant Subject to Plan Check Fee
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This Permit covers work to be done on private properly ONLY.
775-2525
—a
A 1Y eon.lruellmt on the public dnmaln (curbs, sidewalks' drhrowaye,
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