710256.pdfBUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION
Insldo Iienvy Linos
NAME <(Ott
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MAILING ADDRESS
O _._.. I TELEPHONE NUMBER
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NEW
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RESIDENTIAL
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LINE
NON-RESIDENTIAL
❑
SIGN
❑RETAINING
DEMOLISH
WAIT'
❑EXCAVATE
OR FILL
FENCE
(.......... x.......... Ft.)
PRE -MOVE
INSP.
SWIM
POOL
DWELLING
UNITS
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 slate laws regu-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In six months.).
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NOTE: Applicant StiGject to Plan Check Fee
This Permit coven work to be done on private property ONLY.
Any construction on the publle.domain (curbs, sidewalks, driveways,
noaquees, etc.) will require separate permission.
NO.: I NUMBIER 710256
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IDS VAR �B l'TBACK
STREET SETBACK
REAR YARD BETS?
/ /
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USE ZONE__,
LOT AREA
VACANT SITE
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❑ YES NO
,
iEIGHT
BUILDING AREA
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I VARIANCE NUMBEI
?LOT PLAN APPROVED
STREET R/W
EXISTING STREET R/W JPFT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST R/W ........I•'I'.
....?IT _
REMARKS Driveway Slopes not to
exceed those
Lndicated on Standard Drawing_#103.
I � '—'i\f I ❑ YES ❑ NO
SPECIAL INSPECTOR REQUIRED CNOCCUPAN UP /
❑ YES DO I r
PLAN CHECKED B_Y THIS SITE IS LOCATED IN THE
CITY OF EDMONDS. LOCAL SALE
OF EDMONDS. LOCAL SALE
REMARKS TAX SHOULD BE CODED 31.04.
cCopIZ;' *, U&Z t -7o
Valuation
Plan Check No.........
BUILDING
PLUMBING —
HEAT A GAS LINE
FENCE.
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION.
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I
I
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep-
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt Is ac-
knowledged in apace provided.
INSPECTION DIRECTOR'S ION T
DEPARTMENT
CITY OF DATE
EDhiOND$
PR 0-1107 r.-
FILE
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