740098.pdfSIGN
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Fee Receipt No.
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RETAINING WALL
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BUILDING DEPARTMENT Applicant Flli
zo�E _�„y PERMIT 740098
EXCAVATION OR FILL
PERMIT
APPLICATION
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PLOTO PLAN (Indicate Building Setbacks, abuttingstreets
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NAME (OR NAME OF BUSINESS)
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ADDRESS
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ATTENTION
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MPERMISSIBLE '7 ACT L
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will be, employed In or the Labor Code or the Stats of Weshington
relating to Workmen•a Compensation Insurance.
TEUB PEnaI1T
This application Is not a permit until
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MAILING ADDRESS
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NOTE: Permit Limit One Year DEMOLITIONS which
PERMISSIBLE HEIGHT / Pit!USED HEIGHT /)
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uty; and fees are paid, and receipt IB ac-
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ONED UMBEA
ACTUA I.qT L$C; TOT L B %
plated In sig months,)
space provided.
IIGNATURE (OWNER OR AGENT) DATE B10NED
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11,77-71 — �Z
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DEPARTMENT
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CITY OF
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REQUUIIREED YARDS PROPOSED YARDS
NOTE: Applicdn iec fon Check Fee
EDMONDS
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NAME
PR 6.1167
FRONT SIDE REAR FRONT BIDE REAR
Any renalnlellnn an the public demaln (curbs, all—Ike, drlyeways,
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ADDRESS
LE�OcEqg�, LOT VARIANCE OR CONllI IDNAL4S�—
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TELEPHONE NUMBER
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EXISTING REST R/♦l(p.a�'. FICIENCY TH79 PROPER
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COMP. PLAN BT. R/9VW 1S 4R. �,
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Driveway slopes not to exceed those
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indicated on Standard Dwg. NEt103
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TELEPHONE NUMBER
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METER SIZE
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SERVICE SIZE
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CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Deacrlptlon of Property (Show Below or Attach Four Copies)
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
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(OCCUPANCY
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
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NUMBER OF STORIES NUMBER
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NATURE OF WORK TO BE DONE
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SIGN
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Valuation
Fee Receipt No.
RETAINING WALL
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Plan Check N
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BUILDING
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
PLUMBING
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PLOTO PLAN (Indicate Building Setbacks, abuttingstreets
I HEAT A GAS LINF.
TOTAL AMOUNT DUE
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formation given la correct; and that I am the owner, or the duly author -
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ATTENTION
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will be, employed In or the Labor Code or the Stats of Weshington
relating to Workmen•a Compensation Insurance.
TEUB PEnaI1T
This application Is not a permit until
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FENCE
AUTHORIZES
signed by the Building Official or his Dep.
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have reed Ude aDDllcalloa; that me in.
formation given la correct; and that I am the owner, or the duly author -
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(red agent or the owner. I agree to Comply with city and at by Iaws rsgu-
and
lating constmetlon; and in doing the work authorlead tharsby, no person
ATTENTION
APPLICATION APPROVAL
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will be, employed In or the Labor Code or the Stats of Weshington
relating to Workmen•a Compensation Insurance.
TEUB PEnaI1T
This application Is not a permit until
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AUTHORIZES
signed by the Building Official or his Dep.
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NOTE: Permit Limit One Year DEMOLITIONS which
ONLY THE
WORN NOTED
uty; and fees are paid, and receipt IB ac-
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shall he ecmple[ed In ninety day.; MOVED -IN shalt be aom-
knowledged in
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plated In sig months,)
space provided.
IIGNATURE (OWNER OR AGENT) DATE B10NED
INSPECTION
DI 8 BlONATU
2
—,- '"�0-79
DEPARTMENT
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CITY OF
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NOTE: Applicdn iec fon Check Fee
EDMONDS
DAT
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ThisPeemlt Coven work to be dope on Velvets proper{y ONLY.
PR 6.1167
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