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RECORD OF.INSP,ECTIONS_
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PERMITBE740266
BUILDING DEPARTMENT nppucaDtFlll
Inside Heavy Lines
PERMIT APPLICATION
aoB
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ADDRESS
NAME (OR NAME OF BUSINESS)
P:�1kMIB81HLE ^o
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ACTUAL
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LOT COVERAGE
LOT COVES�AOE
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MAILING ADD EBB
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PE51I8tlIBLE HEIGHT
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PROPOSED HEIGHT
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ACTUAL LOT AREA
TOTAL BLDG. AREA
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CITY
TELEPHONE NUMBb:R
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,lel - 5'/3
REQUDIED YARDS PROPOSED YARDS
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NAME
FRONT Slot
REAR FRONT BIDE REAR
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LEGAL LOT VARIANCE OR CONDITIONAL USE
ADDREtlB
l7 YES [D NO PERMIT NUMBER
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DATE:
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CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL
STREET R/W
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN 8T. R/W ............FT.
............FT.
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REMARKS
ADDRESS
OR
CHECKED BY
CITY
TELEPHONE NUMBER
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METER SIZE SERVICE
SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMHEH
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Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
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TYPE CONNECTION
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(VERIFIED
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES I] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL OAe
❑ NEW LINE
❑ YES (:3 NO
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PLAN CHECKED DY
THIS SITE IS LOCATED IN THE CITY
EDMONDS. LOCAL SALES TAX
El NON-RESIDENTIAL ❑ SIGN
OF
SHOULD BE CODED 31.04.
ADD RETAIKING
REMARKS
❑ DEMOLISH ❑ WALL
EXCAVATE ® FF�NCE
ALTER d
OR FILL
1
REPAIR swim
❑ INBYbIOVE O
POOL
1
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
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NATURE OF WORK TO BE DONE
Valuation
Fac Receipt No.
1
Plan Check No .....................
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BUILDING
PROPOSED UBE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT k GAB LIN£
FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
/J03
I hereby acknowledge last I have read this application; that the In-
OC V
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,.,motion given is correct; and that I sum the owner, or the duly author•
Ized agent of the owner. I agree to comply with city and elate laws ago.
ATTENTION
APPLICATION APPROVAL
lating canetructton; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
TRIS 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 THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety day.; MOVED -IN BUILDINGS shall be com.
Imowledged In space provided.
pteted In six months.)
LSTURE (OIVNER AGENT) DATE BiGNED
INSPECTIOND
DEPARTMENT
CITY OF
CTOR' BION9
j� f—+
NOTE: Applicaut Subject to Plan Check Fee9
—
775.2525
This i'rnnll coven work to be dune on Private property ONLY.
Any eo..trurthm an (lie pub to domain (curbs, sidewalks, driveways,
marquees, e1r., wlll require separule permission.
FILE
USE PERMIT
BUILDING DEPARTMENT
Applicant Fla ZONE NUMBER /l
PERMIT ,APPLICATION Inside Heavy Linea
NAME lOR NAME OF BUBINESO)
MAl NO ADORERS
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CITYTELEPHONE NUMBFH
NAME
ADDRESS
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ADDRESe n •..c�
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ACT
LOT COVERAOEc
LOT COVEYIAGE
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PE11MISSIBLF. HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG, AREA
REQUIRED YARDS
PROPOSED YARDS
FRONT SIDE REAL(
FRONT SIDE REAR
ORCI,IAVATE
LLE
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I❑J
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES NO PERMIT NUMBER
91 PLANNING DEPT, APPROVAL DATE:
aj 61TY I TELEPHONE NUMBER
cc STREET R/W
DWELLING
UNITS
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT.
REMARKS
E3 YES C] NO
OF
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Y,
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STREET IMPROVED?i )
i] YES [3 NO
IOUP t
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rED IN THE CITY
(CAL SALES TAX
31.04.
NA'1'U.. us' WVKn 'lU nr3 LU.r.
u RESIDENTIAL
E]GAS
LINE
NEW
❑
NON-RESIDENTIAL
11
SIGN
El ADD
❑
DEMOLISH
NO
WALLEl
ALTER
❑
ORCI,IAVATE
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I❑J
FENCx....
REPAIR
❑
INSP. PRE -MOVE
POOL
(UMBER OF STORIES
l NUMBER OF
DWELLING
UNITS
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT.
REMARKS
E3 YES C] NO
OF
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Y,
ti t
STREET IMPROVED?i )
i] YES [3 NO
IOUP t
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rED IN THE CITY
(CAL SALES TAX
31.04.
NA'1'U.. us' WVKn 'lU nr3 LU.r.
Valuation
Fee
Receipt No.
1
Plan Check N.....6
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BUILDING
W PROPOSED USE
a
PLUMBING
O
aPLOT PLAN (Indicate Building Setbacks, abutting tree[.)
HEAT A GAB LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
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DEMOLITION
i
PRE -MOVE INSPECTION
I
r
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that Wo In.
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formation given ie correct; and that I and the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
toting construction; and In doing the work authorized thereby, no person
,
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Imuranw.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TH
WORK NOTED
uty; and fees are paid, and receipt is ac- j
shalt be completed In ninety days; a10VED-IN BUILDINGS shall be wm-
knowledged in space provided. "
pleted In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
D!R OR'B tll l.TU F
(
DEPARTMENT
%AGE. CGCj�/'�. �J✓L.�C)GG
CITY OF
3j
EDMOND8
DATE It
NOTE: Applicant Subject to Plan Check Fre
775.2525
j
This Permlt cmvre work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, drivewys,
marquees, etc.) will require separate permission.
INSPECTOR
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