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BUILDING DEPARTMENT ApplicantF1LL Off
PERMIT APPLICATION Inside Heavy Lineb JOB ADDRESS
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REAR YARD(. SETBACK
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LOT AREA
VACANT SITE
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YES NOS YES NO
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HEIGHT
I BUILDING AREA
I VARIANCE NUMBER
PLOT PLAN APPItuv GD
EXISTING STREET n/W ............FT.
COMP. PLAN ST. R/W ............FT.
FIRE ZONE
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RESIDENTIAL
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GAS YES
LINEP
NEW
LAN
ADD
NON-RESIDENTIAL
❑
SIGN
RETAINING REIIIW
DEMOLISH
WALL... .. `�
ALTER
❑ OROFILLTE
❑
(ENC x..........Ft.)
REPAIR
PRE -MOVE
1:1
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POOL
INSP.
:UMBER OF STORIES NUMBER OF
/
DWELLING
UNITS
JATURE OF WORK TO BE DONE
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Plan
❑ NO
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BUILDING
PLUMBING ----1111
HEAT & GAS LINE
FENCE
SIGN
I RETAINING WALL
N
ISWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state taws regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
shall be completed In ninety day$; MOVED -IN BUILDINGS shall be com-
pleted In six months.)
SIGNATURE (OWNER O,g AGENT) DATE SIGNED
INSPECTION
CT 1 —17- 7 /
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
_
PR 8-1107
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permisslon.
DEFICIENCY THIS PROPERTY
............FT.
❑ YES [] NO
Valuation I Fee
No.
APPLICATION APPROVAL "
Tllis application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
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RECORD OF INSPECTIONS
Date Passed
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