740157.pdf-7
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BUILDING DEPARTMENT
VBNE �S '�
NUMBER 740157
Applicant F1ll
L[gida s
PERMIT APPLICAT
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o� Seg
ADDRESS
NAME (OR NAME OF BUSINESS) �y
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PETRMISS
LOCOVIBERLEAGES
ACTUAL
1.OT COVE�iAGE
_
AILING AD REe
SQ ;;1,
�J /CY
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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CITY
T) P ONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
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REQUIRED YARDS
SE
PROPOD YARDS
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NAME FRONT BIDE
REAR FRONT SIDEREAR
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-1 1 Z
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ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL
0 YES ❑ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DAT
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C1TY TELEPHONE NUMBERI-
BTREET A/WD
EXISTING STREET RAW ............
FT. DEFICIENCY THIS PROPERTY
-
NAME
COMP. PLAN 8T. R/W ............FT.
............FT.
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REMARKH
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DREBB/
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CHECKED BY
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CITY/�/j^'
NUMBER
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/TELEPHONE
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METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Coples)
REMARKS
QU
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TYPE C NN�EECCTIIONN(t�`,,
•J VERIFIED BY
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PERC. TEST
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"'MIT NUMER
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REMARKS
FIRE ZON TYPE OF CO UCTlON STREET IMPROVED
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YES [] NO
OAB
SPECIAL INSPECTOR REQUIRED OCCUPANCY G7
❑ YES ❑ NO
RESIDENTIAL LINE
PLAN CHECKED
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NEW
Ej NON-RESIDENTIAL
BY
THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SIGN/
ADD ❑ AERETAINING
DEMOLISH WALLMARKS
RE
cH0 1 D B nnpD it n4
ALTER EXCAVATE FENCE
OR FILL (.._......z..........Ft.)
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REPAIR PRE-MOVSWIM
INSP. POOL
NUMBER OF STORIES NUMBER OF
1
DWELLING
UNITS
NATURE OF WORK TO HE DONE
Valuation Fce Receipt Ne.
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Plan Check No.....................
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BUILDING
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PROPOSED USE
PLUMBING 3,
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT &CAS LINE
tl
FENCE
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SIGN
RETAINING WALL'
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
PIE
EXCAVATION OR FILL
Ihereby acknowledge that I have read this application; that the In•
TOTAL AMOUNT DUE
/� S 761-1d
formation given Is correct; and that I am the owner, or the duty author-
Iced agent the owner. I agree toe comply with city and state Mn ergo-
tr
latlog construction; and In doing the work authorlaed thereby. no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TH
ut and fees are paid, and receipt is aC-
Y P
plate be completed to meaty days; MOVED-IN ]BUILDINGS shall be nom-
woRA NOTED
OT'
knowledged in space provided.
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peeled n six months.)
SIGNATU (OWNER OR ENT) DATE SIGNED
INSPECTION
DIRECTO B 8! N
DEPARTMENT
CITY OF
EDMONDS
aw•rE _
NOTE: Applicant Subject to Plan Check Fee
PR d-1107
This Permit covers work to DO done an prlveta prolMrly ONLY.
Any eanstructloa on the public domaln (curbs, sidewalks, driveways,
'1' c• uA. e t.
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