750121.pdfUSE
BUILDING DEPARTMENT AppllcantFlll °
PERMIT APPLICATION Insldo IleaYy Linos ,—�
ADDS
NAME
,(ORR�VAAME up BUSINESS)
J . SIU PI"P P`4I`-C I r+ LOT"I
IAT 1
m MAILING ADDRE S PERM
£ IES
IZo I TELEPHONE NUMBER ACTU
CITY
ED14OM PS
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H
7
J
PERMIT 750 2
NUMBER
REAR FRONT SIDE REAR
romo"a 1-/75 - 2 W
or Attach Four Copies) &—�f.5/ /
jo,.n.: OG TYPE CONNECTION I VERIA
Q YES Q NO
PERMIT NUMBER
PLANNING DEPT. APPROVAL
DATE:
Q YES NO
-TELEPHONE NUMBER
STREET R/W
EXtSTIN6 STREET
COSfP. PLAN ST.
R/W ............FT.
R/W ............FT.
DEFICIENCY THIS PROPERTY
............FT.
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REMARKS
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SHOULDOFEDMONDSeE CODEDLOCAL 31.04.SALES
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&C'194
REMARKS
ry� r� O
REMODEL.- Nvy
FENCE
® ALTER EJOR cAFILLvA E (..........X......._Ft.)
I CHECKED BY
romo"a 1-/75 - 2 W
or Attach Four Copies) &—�f.5/ /
jo,.n.: OG TYPE CONNECTION I VERIA
G'Xr s T N/C
FIRE- TYPE OF CONSTRU ION BTREET IMPROVED s
YES [:I NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
Q YES NO
I
IN THE CITY
CAB
RESIDENTIAL LINE
NEW
PLAN CHECKED BY
THIS SITE IS LOCATED
TAX
NON-RESIDENTIAL ❑ SICN
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SHOULDOFEDMONDSeE CODEDLOCAL 31.04.SALES
'
...RETAINING
❑ADD ❑DEMOLISHO WALL
REMARKS
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REMODEL.- Nvy
FENCE
® ALTER EJOR cAFILLvA E (..........X......._Ft.)
'NO"
i
E] REPAIR
❑ INSPMOVE POOL
NU5IBER OF BTORI ES NUMBER OF
DWELLING .�—
I
UNITS
Valuation Fee Rccclpt No.
NATUURRE OF WORRKI TOBE DONE
Ort -IGS /�"�TrrJ�
Plan Check No.
BUILDING
PLUMBING
O
3�toa 13t0I J
l
I
PROPOSED USE
O
PLOT PLAN (Indicate Building setback., ¢butting street.)
HEAT A GAS LINE
I
FENCE
SIGN
tRETAINING
WALLI
I
�
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
j
EXCAVATION OR FILL
TOTAL AMOUNT DUE
s(JI
I hereby acknowledge that I hevs read this application; that the In-
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i
formation given Is correct; and that I am the owner, or the duly author-
leed agent of the owner. I agree to comply with city and .late laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
Labor Code the Slate of Washington
THIS PERMIT
This Is not a permit until
will be employed In Violation of the of
relating to Workmen's Compensation Insurance.
AUTHORIZES
application
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Eicept DE51OLITIONS which
NLY TI 'E
{YORK NOTED
uty; and fees are paid, and receipt is He
.hall he completed In musty days; MOVED -IN BUILDINGS shall be cam.
knowledged In space provided.
pleted In .1.months.)
SIGNATURE (OIVNER OR AGENT) DATE SIGNED
INSPECTION
D1REC IS S1ONA
I�!
DEPARTMENT
r
CITY OF
EDMONDS
DA 1
NOTE: Applicant Subject to Plan Check Fee
775-2525
This I'ermlt cosrn work la be done an private property ONLY.
Any construction onthe public domain (curbe, sidewalk., driveways,
FILE
Univ •i,, "111 r.rnnire nrpnrotr Irrrmi..i.n.
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71
a;.
RECORD OF INSPECTIONS
i
Date Passed
Foundation
1 I
Plumbing (Partial)
,
(Rough)
Frame
Furnace & Fuel Lines
_.
Final
Q
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