740153.pdf0 YES 0 NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
OYES OO
RESIDENTIAL LINE PLAN CHECKED BY
NEW THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL SIGN SHOi)DLD BE CODED 3LOC1045ALE5 TA)I
ADD ❑ DEMOLISH ❑ WALL NINC REMARKS
ALTER ❑
ORFILL
EXCAVATE ❑ FENCz..........Ft.)
REPAIR ❑ INSP. MOVE O swim
POOL
iUMSER OF STORIES I NUMBER OF
DWELLING
NATURE O • ORK TO BE DON
Valuation
F.. Receipt No.
Plan Cheek Nn .....................
BUILDING
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F1111
BUILDING DEPARTMENT Applicant Fl
NUMBER
740153 ZUSE
ONE PERMIT /-• I �_�
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aPLOT PLAN (Indicate Building setbacks, abutting Streets) HEAT A GAS LINE
PERMIT APPLICATION Inside Heavy IaD°°
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ADDRESS
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NAME O NAM OF S)
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ACTUAL
SIGN
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LOT COVERAGE LOT COVES�AOE
LOT COVERAGE
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SWIMMING POOL
MAI 10 ADDRESS
PERDIIdBIRLE HEIGHT PROPOSED HEIGHT
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DEMOLITION
AREA TOTAL BLDG. AREA
PRE -MOVE INSPECTION
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CITY TE EPHONE NUMBB:R
ACTUAL LOT
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REQUIRED YARDS PROPOSED YARDd
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2 hereby acknowledge that I have road this eDpftcntlon; that We In-
FRONT HIDE REAR FRONT BIDE REAR
form¢tion given Ie correct; and that I — the owner, Or the duly author-
lmd agent of We owner. I agree to eomD1Y with city and .(ate Taws raga- ATTENTION
,.H.. tons Mellon: and m doing the wont authorized thereby, no person
Will be employed In violation of the Labor Code of the State of Weshinston TIDE PERMIT
relating to Workmen's Compensation Imalmos. AUTHORIZES
signed by the Building Official or his Dep -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
.hail be completed In ninety days; MOVED -IN BUILDINGS shall be wm•
NAM
pleted In six ...the.)
SIGNATURE (OWNER OR AGENT) DATES NED INSPECTION
G+ .r1 DEPARTMENT
2' rT CITY OF
EDMONDS
NOTE. Applicant bject to Plan Check Fee PH 6-1107
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This Permit coven work to be done on private property ONLY.
Any construction on the public domain (enrbe, sidewalks, driveways,
..quem, etc.) wW "Ofir. separate permission.
LEGAL LOT VARIANCE OR CONDITIONAL USE
aUj
ADDRESS
0 YES 0 NO PERMIT NUMBER
N
PLANNING DEPT. APPROVAL DATE:
TE PHONE
CITY NUMDER
STREET R/W
EXI8TIN0 STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME I
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDRESSlit
7 - �. ul
BY
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CT TELEPHONE NUMBER
(CHECKED
zoUggYLIWim'"/.
METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
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STA T,e( LICENSE NUMBER I CITY (CENSE NUMBER
0 YES 0 NO
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
OYES OO
RESIDENTIAL LINE PLAN CHECKED BY
NEW THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL SIGN SHOi)DLD BE CODED 3LOC1045ALE5 TA)I
ADD ❑ DEMOLISH ❑ WALL NINC REMARKS
ALTER ❑
ORFILL
EXCAVATE ❑ FENCz..........Ft.)
REPAIR ❑ INSP. MOVE O swim
POOL
iUMSER OF STORIES I NUMBER OF
DWELLING
NATURE O • ORK TO BE DON
Valuation
F.. Receipt No.
Plan Cheek Nn .....................
BUILDING
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Y PROPOSED USE PLUMBING
3. S O
O
aPLOT PLAN (Indicate Building setbacks, abutting Streets) HEAT A GAS LINE
9
O FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION On FILL
1
TOTAL AMOUNT DUE
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2 hereby acknowledge that I have road this eDpftcntlon; that We In-
APPLICATION APPROVAL
This application is not a permit until
form¢tion given Ie correct; and that I — the owner, Or the duly author-
lmd agent of We owner. I agree to eomD1Y with city and .(ate Taws raga- ATTENTION
,.H.. tons Mellon: and m doing the wont authorized thereby, no person
Will be employed In violation of the Labor Code of the State of Weshinston TIDE PERMIT
relating to Workmen's Compensation Imalmos. AUTHORIZES
signed by the Building Official or his Dep -
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
.hail be completed In ninety days; MOVED -IN BUILDINGS shall be wm•
uty; and fees are paid, and receipt is ac
knowledged In space provided.
pleted In six ...the.)
SIGNATURE (OWNER OR AGENT) DATES NED INSPECTION
G+ .r1 DEPARTMENT
2' rT CITY OF
EDMONDS
NOTE. Applicant bject to Plan Check Fee PH 6-1107
DIRE R'S 8(6NATU
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DAT
ry
— of
FILE
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (enrbe, sidewalks, driveways,
..quem, etc.) wW "Ofir. separate permission.
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BUILDING DEPARTMENT
SONE PERMIT i1'^�
Applicant FW
PERMIT APPLICATION Inside Heavy Lines
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ADDRESS / / / /� /) /, // .
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NAME OY NAIi$ OF HUB e)
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PERMISSIBLE ACTUAL
LOT COVERAGE LOT COVERAGE
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MwILI a,wDD EBB
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITYTELEPHONE
NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
NAME
FRONT BIDE REAR FRONT dIUE REAR
LEGAL LOT VARIANCE Ott CONDITIONAL UBE
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ADDRESS
YE9 NO PERMIT NUMBER
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al
CITY
EPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
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STREET R/W
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN BT. R/W ............FT. ............FT,
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REMARKS+
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ADDRE 8
d
W
CHECKED BY
TELEPHONE NUMDER
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METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
STATVVE LICENBE NUMBER
CITY LICENSE NUMBER
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REMARKS
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1111
Legal Description of Property (Show Below or Attach Four Coyle.)
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
� YES NO
SPECIAL INSPECTOR REQUIRED
OAOUP
RESIDENTIAL
GAS
❑ LINE
[j YES 0 NO
(OCCUPANCY
❑ NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
OF S. LOCAL SALES TAX
s1aN
;'�� -- H LD BE CODED 31.04.
ULD BE D
ADD ❑ DEMOLISH ❑ RETAINING
NINO
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❑FENCE
ALTER EXCAVATE
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❑
OR FILL (..........x.......... Ft.)El
REPAIR ❑ swim
INSEP. 1:3POOL
NUMBER OF STORIES NUMBER OF
1�
DWELLING
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llNL -B
NATURE OP/WORK TO BE DON /f
Valuation
Fee
Receipt No.
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Plan Check No.....................
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BUILDING
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PROPOSED
USE `(
1 1
PLUMBING
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OPLOT
,
PLAN (Indicate Building setback., abutting streets)
HEAT A GAS LINE
9
D
PENCE
j
SIGN
I
-
RETAINING WALL
-
SWIMMING POOL
1
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 r-
the owner• or the duly autho
l
lred agent of the owner. I agree to Comply with City and state laws regu-
ATTENTION
APPLICATION APPROVAL
lalmg coestruclmil; aad In doing the work authorised thereby, no person
Will be employed In violation of the Labor Code of in. State of Washington
THIS PER511T
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHOIUZE8
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TRE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shall be completed in ninety days; MOVED-IN BUILDINGS shall be win-
knowledged In space provided.
pleted In six months.)
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SIGNATURE (OWNER OR AGENT)
DATE 81ONED
INSPECTION
DIA aTOR•B 81 NATO E
.
DEPARTMENT
\
CITY OF
EDIVIONIDS
NOTE: Applicant Subject to Plan Check Fee
PR 0-1107
This Permit corm work to be done oa private property ONLY.
Any construction ou the public domain (carbo, sidewalks, dri-7.,
INSPECTOR
marqure., Cie.) wW require separate permission.
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