750465.pdfI
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
BUILDING DEPARTMENT
Applicant Fill
UNE �I� PERM
75046-7
GAS
❑ YEN I.10
PERMIT APPLICATION
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NEW
LINE:
PLAN CII F:CICFID BY
THIS SITE IS LOCATED IN THE CITY
ADDREeB (/J
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Z NON-RESIDENTIAL
NAME (OR NAME OF BUSINESS)
/
ADO
ARTAINING
PER ItltlIBLE '^ AC A
ISHERAOEe
SHOULD BE CODED 31.04.
E] DEMOLISH WALL
IATne
LOT COViLGM
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MAILING ADDRESS
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E REPAFR PILE-AtOVF. WIM
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CITY
TECLEPHONE NUMBER
REA 9OTA AREA
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BE UIRED YARIM PROPOHNI) YAItUH
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NAME
FRONTSIDF: REAR FRON HIDE HEAR
NATURE OF WORK TOF DONE
ADDRESS
Vnlurtllon
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CITY
TELEPHONE NUMBER
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STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
PLUMBING
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NAME
COMP. PLAN ST. R/W ............FT. ............1".
PLAN (I.iIcnto Pulldinx setback., nbuillnu M—t.)
IIEAT @ OAS LINE
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REMARICS
ADDRESS
FENCE
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CHECKED BY
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CITY`s�
T�]ELEPHONE NUM/BER
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METER NTLI: SERVICE SIZN CLEARANCE CHECKED BY
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STATE LICENSE Nr�UYfH
CITY LICENSE NUMBER
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EXCAVATION OR FILL
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
+ i
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In-
TYPE CONNECTION VERIFIED BY
formation given 1. correct{ sad Mw
at 1 n Ilia owner, or the duly author.
f"
Ized agent or the owner. I agree to comply with city and state laws ragu-
ATTENTION
I ERG. TEST PERMIT NUMBER
lating construction; and In doing the work authorized thereby, no person
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This application is not a permit until
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relating to Workmen's Compensation Insurance,
AUTHORIZES
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NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY TILE
WORE NOTED
uty; and fees are paid, and receipt is ac-
'
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
pleted In el. ...the.)
Ir11lE y E TYPE OF CONSTRUCTION STREET IaIPltGYED
tl10NA ' : (O{VNER Olt A T) DATE 81GN D
0 YES 0 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GAS
❑ YEN I.10
F— 2,'
I
NEW
LINE:
PLAN CII F:CICFID BY
THIS SITE IS LOCATED IN THE CITY
!�
Z NON-RESIDENTIAL
NIGN
OF EDMONDS. LOCAL SALES TAX
ADO
ARTAINING
"MAH".
SHOULD BE CODED 31.04.
E] DEMOLISH WALL
ALTER
EOltXCAVATE ❑ ('ENC=..........P1•)
E] FILL
E REPAFR PILE-AtOVF. WIM
❑ INHP. POOI,
NUMBER OF STORIES NU AID'll OF
D W FELLING
I
UNITS
NATURE OF WORK TOF DONE
Vnlurtllon
Feq Receipt No,
flan Cheek N
BUILDING
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PROPOSED UNE
PLUMBING
' '
D
aPLOT
PLAN (I.iIcnto Pulldinx setback., nbuillnu M—t.)
IIEAT @ OAS LINE
FENCE
HIONs'3
RETAINING WALL
N
SWIMMING POOL
DEATOLITION
PRE -MOVE. INSPECTION
EXCAVATION OR FILL
'
I
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In-
formation given 1. correct{ sad Mw
at 1 n Ilia owner, or the duly author.
Ized agent or the owner. I agree to comply with city and state laws ragu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In vtolatlun of the Labor Code of the Stale of Waahlbglun
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance,
AUTHORIZES
Sighed by the Building Official or his Dep -
---
NOTE: Permit Limit One Your (Except DEMOLITIONS which
ONLY TILE
WORE NOTED
uty; and fees are paid, and receipt is ac-
'
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in space provided.
pleted In el. ...the.)
tl10NA ' : (O{VNER Olt A T) DATE 81GN D
INSPECTION
DIREC '�,R
DEPPECTIONT
CITY OF
EDhiONDS
nwT
NE:OTApjllicant Subject to Plan Check Fee
—
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775-2525
_
This Permit r'ark to be done on prlV tl property ONLY.
Any Caner nirllm, n the pnhilc (rnrbs. sidewalk,, drirewnys,
FILE
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