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PERMIT APPLICATION Inside Heavy Linea A
NAME11 (OR NAME OF BUSINESS)
MAILING ADDRESS Pl
W
F
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C
L
G ADDRE88
-
C CITY TELEPHONE NUMBER
g S i4iC� I RT4 LA 2-0
STATE LICENSE NUMBERCITY LICENSE NUMBER
.�-�Z
NEW
L1 RESIDENTIAL
❑
LINE
ADD
ALTER
REPAIR
9
NON-RESIDENTIAL
®
ElFENCI.x..........Ft.)
O
SIGN
RETAINING
WALL
SWIM
❑
❑
DEMOLISH
On FILL EXCAVATE
PRE -MOVE
UMBER OF STORIES
I NUMBER OF
BUILDING
,�-
DWELLING
PROPOSED USE
UNITS
—�
U
aPLOT
'ATURE OF WORK TO BE DONE
PLUMBING
01A
•++'JI ii1 I YE8 �,NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY OIlOUP
O YES --o.. — -L-
PLAN
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
valuation
1 "
Plan Check
KJ 1
9
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BUILDING
PROPOSED USE
U
aPLOT
PLUMBING
PLAN (Intlleato Building eetbnoke, abutting etrcota)
HEAT & GAS LINE
FENCE
)
SIGN
0
RETAINING WALL
N
—
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
,
�—
/3
TOTAL AMOUNT DUE
i hereby acknowledge that I have this
read application; that the In.
formation Riven le correct; and that I am the owner, or the duly author -
a
Iced agent the owner. I ogres to comply with city and elate laws ergo-
toting construction; and In doing the
ATTENTION
APPLICATION APPROVAL
w
worr k sulhorl:ad thereby, no person
will be employed In violation of the Labor Code of the State of Wmhmgton
relating to
T11I8 PERM[T
This application is not n permit until
Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS
AUTHORIZES
ONLY THE
signed by the Building Official or his Dep--�.------•
which
b
{SORT{ NOTED
Uty; and fees are paid, and receipt Is ac -
shall completed In ninety days; MOVED -IN BUILDINGS Shall be Som-
knowledged In apace
provided.
SIGNATURE (OWNER OR AGENT) DAT SIGNED
INSPECTION
DIRECTOR'S 810NAT
tY/-V�OIw'LT•,
DEPARTMENT
A-
CITY OF
NOTE; Applicant Subject to Plan Check Fee
EDbIOND9
DATE
775-2525
This Permit cave. work to bo done an privets property ONLY.
Any eonetrnetlmt a,, 'he public damaln (enrbe, eldrw'nike, drirewaye,
:iraarrs, el— „III ri•n alr,.Sporule trrniteelen.
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`750%R'3 `•'
RECORD OF INSPECTIONS
I
Date Passed L i
7J
Foundation
Plumbing (Partial)
(Rough)
Frame --- ---
Furnace & Fuel Line _� 2 _"_
Final .