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750233.pdfi 20NE - NUMDIEIi 502,11 BUILDING DEPARTMENT Applicant Fill y 8 PERMIT APPLICATION Inside fleavy Lines I o ADDRESSNAME/��i NAE (OR NAME ON BUSINESS) I L( JI IBJ AD F__ H I _ AM � PERM ov"TLE ACTUAL ,D LOT COYERAOEe 2 � iJ I^ LOT COVESiAOE J (fit.] ( � C MAILING ADDRESS XQII 15 Mt'k1 nl 1 �-+- PEIi\I IOBLY HEIGHT `PILOPO qAjh�` HEIGHT p CITY TELEPHONE NUMHhR t Tf(YYAADTAL BL . AAEA n ACTUAL LOTyA,REA , / V p 0 $Z� Iaitt��l/S-'aO-%T OV7 3 �f ` © d —�y �Q RL�IR D YARDS PROPOSED YAROd i4 ; NAME FRONT SIDE REAR FRONT SIDE REAR �. 01! 11yr d/TM b LKt) I. I.OT y VARIANCE Oft CONDITIONAL USE •�/ kUj h AllDltEtld 9 NO PERMIT NUMBER •A U1 C CITYI TELEPHONE NUMBER NO T VAL d U R/lV [� � EXIB NG STREET R/w�! .... DEFICIENCY THIS PROPERTY ;e; NAME. COMP. PLAN ST. R/V��%Z.. .... 0 -FT. W t -/ d REMARKS riveway s open not to exceed those ADDRESS indicated on Standard Dwg. No. 103 w (((o TELEPHONE CHECKED BY CITY NUMBER utirx� }�Ictnl� W 12ttJs 1�►�`n O STATE LICENSE NUMBER CITY LICENSE NUMBER METF.I�BILE BERV3�E SIZE I CLEARANCE C BY 3� a , / Below REMARKS Legal DeecNptlan of Property (dhow or Attach Four Copies) TYPE CONNECTION VERIFIED BY �nI /1�/.}-/�• PERO—. TES PL i�Ml U fBER fL • `T/ W REMARK9 PIVD rWn II "t FIRE TYPE OF CONSTRUCTION STREET IMPROVED n /J El YES )rNO SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP GA9 RESIDENTIAL ❑ YESNO y LINE NEW PLAN CHECIS D DY PLAN SITE IS LOCATED IN THE CITY NON-RESIDENTIAL aIGN OF EDMONDS. LOCAL SALES TAX SHOULD 1E CODED 31.04. non RETAINING DEMOLISH O REMARKS ALTER EXCAVATE PENCE u 6�` —� 1 , � �+ u -s -r E]H OR FILL (.......... Y_ ........ Ft.) REPAIR ❑ IRE -MOVE O SWIM POOL M EC '� to U B C NUh1UER OF BTOIt1 EB NUMBER OF DWELLING 1 UNITS NATURE yOF1` I)WORK TO ➢E DON�E1,(��( / Vnlunllan Fee Receipt No. .,an Check No ..................... yr BUILDING PROPOSED USE PLUMBING , 4 PLOT PLAN (Indicate Building setbacks, butting 6 etrcete7 ) HEAT A GAS LINE o / 131119. FENCE I SIGN RETAINING WALL N SWIMMING POOL DEMOLITION PRE -MOVE INSPECTION EXCAVATION OR FILL TOTAL AMOUNT DUE o D-. I hereby acknowledso that I have rend this application; that the In. 0 t ' formation Riven iscorrect; and that I am the owner, or the duty author- , Iced agent of the owner. I agree to Comply with ally and state law. regu- ATTENTION APPLICATION APPROVAL lating construction; and In doing the work authorized thereby, no person will be employed In Violation of the Labor Code of the State of Washlagton 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 DEMOLITIONS which ONLY THE -^---" WORK NOTED uty, and fees are paid, and receipt is ac - &hall be completed In ninety days; MOVED -IN BUILDINGS .hall be corn- knowledged in space provided. pleted In six months.) SIGNATURE (OWNER OR AGENT) DATE SIGNED INSPECTION DIRE OR'8 SIGNATURE DEPARTMENT /VvneM:TJr '.►/_�...:a..�:iJ ' ,TSI � ftT� CITY OF ATE: Applicant Subject to Plan Check Fee EDMONDS DT 775-2525 This Permit cover& work to be done On private property ONLY. Any Canel r urtlan an the PubAmm�ln (curb., nMewallre, drh'ewoys' FILE .,r�lnr•r, .1,', ,III r,��lalr, nr11-.6. pernileslan, VAL to UPC RECORD OF INSPECTION", Date Passed Foundation Plumbing (Partial) (Rough) Frame Furnace & Fuel Lines - Final Apy P0 /0r0L)X- 5,,cJl C ,Aptcll ,,j C- J VAL to UPC RECORD OF INSPECTION", Date Passed Foundation Plumbing (Partial) (Rough) Frame Furnace & Fuel Lines - Final Apy P0 /0r0L)X- 5,,cJl C ,Aptcll ,,j C-