740204.pdfI
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BUILDING DEPARTMENT ApplloantF111 ZONE NUMBETR 740204
PERMIT APPLICATION Inside Heavy Lines ,O
NAME (OR NAME OF//B''jUBINE88) ADDRESS $5-0 4 MIC ICJ �" •'
G�e/r/ /a , �/✓e ��/� LOTPERaISSIBLE
COVERAOE� / e r LOT COVERAGE
MAILING ADDRESS
/J PERMIS7SIBLE HEI3HT PROPOSED HEIGHT a
���✓�%/�P/eGlJaa � �iT/IJ
C� yJ A/1 ///' /1I '1TELEPHONID ER ACTUAL LOT AREA TOTAL BLDG. AREA
,�/ ,✓�� -w�l ��,— REQUIRED YARDS PROPOSED YARDS
NAME FRONT SIDE REAR FRONT BIDE REAR
eVj ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL USE
F� Q YEB NO PERMIT NUMBER
O PLANNING DEPT. APPROVAL DATE:
C< CITY TELEPHONE NUMBER I.
STREET R/W
NAME EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN 8T. R/W ............FT. ............FT.
REMARKS
G7 ADDRESS
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CHECKED BY
h CITY TELEPHONE NUMBER '
E
V METER GILL SERVICE SIZE CLEARANCE CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
E
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Legal Description dI Property Below
REMARKS
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(Show or Attach Four Copies)
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TYPE CONNECTION
BY
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(VERIFIED
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TEST
PERMIT NUMBER
aPERC.
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REMARKS
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FIRE ZONE TYPE OF CONBTRUCTION STREET IMPROVED
YES [] NO
SPECIAL INSPECTOR REQUIRED
GROUP
ElRESIDENTIAL
GA13
❑ YES Ej NO
(OCCUPANCY
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NEW
LINE
PLAN CHECKED BY
THIS
SITE IS LOCATED IN THE CITY
ADD
NON•REBIDENTIAL
SIGN
SHOEDD OND ODED 3AL SALES TAX
•',
RETAINING
DEMOLISH WALL
REMARKS
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EXCAVATE I01 FE�N�O�E
ALTER ❑ �
OR FII(. {
•�)
REPAIR ❑ INSPMOVE D swim
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK BE DONE
Valuation
Fee Receipt Na.
Plan Check No .....................
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BUILDING
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PROPOSED USE
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PLUMBING
O PLOT PLAN (Indicate Building setbacks, abutting elreete)
HEAT &GAS LINE
5
FENCE
1 O O
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
AMOUNT DUEcallen;
I heresy acknowledge that I neva rand this application;that the In.
rermmlon given Is correct; and that I am the owner, or the duly author.
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fled agent or the owner. I agree to eomDlY With city and .late law. mile.ATTENTION
Inti.. coaetructloa; and In doing the work authorized theteby, no person
APPLICATION APPROVAL
will be employed In violation or the Labor Code of the Stale of Washington
THIS PERMIT'
relallgg to Workmen's Compensation Ins urines.
This application is not a permit until
AUTDURIZEB
signed by the Building Official or his Dep-
al---"-'— -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIIE
fees
shall be completed In ninety days; MOVED -IN BUILDINGS shell be com-
WORK NOTED
uty, and, are paid, and receipt is ae-
pleted In six months.)
space knOWled ed in 8
g p e provided.
SIGNATURE OR AGENT)DATE SIGNED
INSPECTION
Moll
/
DEPARTMENT
DI R OR'S IONATU
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Flan Check Fee
This Permit covers work to be done on private property ONLY.
PR 6.1107
Any c... i n ti- on the public domain (curb., .Idewalk., drlreway.,
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