740172.pdf..
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BUILDING DEPARTMENT Ffu
PERM
ONE NUMB1ER 740 172
appueant
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Inside Heavy Lines
PERMIT APPLICATION
ADDRESS
NAMD loft NAME "M
/ O
5
PER ^e ACTUAL qq
VERAGE LOT COVERAGE
1 '
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MA1LI O ADDRESS
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LOT COMISSIBLE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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oOI/TYo�j
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TDLEPH?ONE NCVjMByg/:ft
'ACTUAL LOT AREA TOTAL BLD.. AREA
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REQUIRED YARDS PROP.BED YAR.UB
NAME
FRONT SIDE AEA. FRONT HIDE REAR
1y
U
ADDRESS
LEGAL LOT VA ANCE OR CONDITIONAL USE
O YES O NO PERMIT NUMBER
.y�..y,
-FLAN"
V
CITY
TELEPHONE NUMBER
N6 DEPT. AP ROVAL DATE;
STREET R W
/
I,
EXISTING STREET R W ............FT. DEFICIENCY THIS PROPERTY
/
NAME
COMP. PLAN ST. R/W ............FT. ...........,FT.
REMARKS
ADDRESS
X
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CHECKED BY
'
CITY
TELEPHONE NUMBER
[+
Z
METER 812E
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 F¢Ur Copies)
REMARKS
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TYPE CONNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
09
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REMARKS
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1
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
I YES [3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
❑ RESIDENTIAL
OAS
❑ YES NO
❑ NEW
❑ LINETHI
PLAN CHECRED BY THIS
SITE IN THE T
IS LOCITY
!
❑ NON-RESIDENTIAI,
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
❑ ADD RETAINING
❑ ❑ WALL
REMARKS SHOULD SE CODED 3104
DEMOLISH
❑ ALTER EXCAVATE FEN
Section 12.14.040 (fence 2`etj1112'elllentS)
❑ OR FILL (........:....LLFI.)
❑ REPAIR E]PRE-MOVE8 M
INSP. ❑ POOL
attached.
.
NUMBER OF STORIES NUMBER OF
DWELLING
I
UNITS
NATURE OF WORKE DONE
valuation
Fee Rcecipt No.
Plan Check No.... _...............
C
BUILDING
[.�
PROPOSED USE
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PLUMBING
;Tal
PLOT PLAN (indicate Building setbacks, abutting street.)
HEAT & GAS LINE
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FENCE
SIGN
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RETAINING WALL
SWIMMING POOL
DEMOLITION
!
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowletlge that I have reed this application; that the In.
formation given Is correct; and that I am We owner, or the duly nuthor-
Ieed agent of the owner. I agree to comply With city and stale law. regu-
ATTENTION
APPLICATION APPROVAL
lating con.tructlo¢; and In doing the work authorised thereby, no person
Will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a perrait until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except nEMOI.ITIONS which
ONLY TI IE
{YORK NOTED
uty; and fees are paid, and receipt Is ac-
shall be completed In musty days; MOVED-IN BUILDING" She,, be cone-
l nowledged in Space provided.
plated 1 .is months.)
SIG RE (OWNER OR A.ENT)
DATE BIOND
INSPECTION
DEPARTMENT
DI TOWS qlONAT /_ _
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CITY OF
j`; tii�.)�f 11?.!.G✓:jf_�
14DATE
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
74!
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PR 6-1107
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This Permit corers work to be done an Drlvate property ONLY.
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Any construction an the p.bit. domain (,-be. r'• —flus, drlveways,
marquees, etc.) will require .epuratel I.slon.
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