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RESIDENTIAL I
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GAS
LINE
NEW
zONE NUMBER 740278
BUILDING DEPARTMENT AppLPAiltFill
❑
NON-RESIDENTIAL
PERMIT APPLICATION Ineido Heavy Lines JOB
SIGN
ElADD
❑
ADDRESS
��
O
RETAI
WALL NINC
ALTER
NAb1E (OR NAME OF BUSINESS)
EXCAVATE
ORFILL
❑
G. x .......... Ft.)
m ACTUAL
❑
N PbIOVE
❑
LOT COVERAGE; LOT COYEAGE
LOT C VERA
1UbIBER OF STORIES
NUMBER OF
m
a
I
MAILING ADDRESS PEItD]IBSIBLE HEIGFIT PROPOSED HEIGHT
S'
DWELLING
S�iPUI' TOTAL BLDG. AREA
Z
a
5F
CITY
TE%LEPH�OjNENU,D%68EA ACTUAL LOT AREA
FENCE
E,pM,9A1D_5
REQUIRED YARDS PROPOSED YARDS
REAR FRONT BIDE REAR
SIGN
NAME FRONT BIDE
tRETAINING
WALL
1iyy
LEGAL LOT VARIANCE OR CONDITIONAL USE
N
0 YESE3 NO PERMIT NUMBER
WAUDREBB
F
PLANNING DEPT. APPROVAL DATE.
DEMOLITION
O NUMBER
CITY
R/W
(TELEPHONE
STREET
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
a
PRE -MOVE INSPECTION
NAME
COMP. PLAN 8T. R/W ............FT. ............FT.
EXCAVATION OR FILL
REMARKS
n
C ILD-
x
W
1
/
( /�
F CHECKED BY
Cc+
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In.
CITY
TELEPHONE NUMBER
I
rormatlon given Is correct; and that I are the owner, or the duly author-
F
A
VMETER
RILE I SERVICE SIZE I CLEARANCE
I CHECKED BY
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E] YES 0 NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
0 YES 0 NO
PLAN CHECKED BY THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
Nc.
RESIDENTIAL I
[]
GAS
LINE
NEW
BUILDING
❑
NON-RESIDENTIAL
El
SIGN
ElADD
❑
DEMOLISH
O
RETAI
WALL NINC
ALTER
❑
EXCAVATE
ORFILL
❑
G. x .......... Ft.)
® REPAIR
❑
N PbIOVE
❑
POOL
1UbIBER OF STORIES
NUMBER OF
.a PLOT PLAN (Indicate Du116Ing eetbncks, abutting sitter;)
BEAT A GAS LINE
DWELLING
UNITS
E] YES 0 NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
0 YES 0 NO
PLAN CHECKED BY THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
Nc.
Plan Check No .....................
BUILDING
ra
L PROPOSED USE
VV
'y7
PLUMBING
3
.a PLOT PLAN (Indicate Du116Ing eetbncks, abutting sitter;)
BEAT A GAS LINE
�
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
/
( /�
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In.
G Q O
\
rormatlon given Is correct; and that I are the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and ;into laws regu-
ATTENTION
APPLICATION APPROVAL
(ming constructlon; and In doing the work authorized thereby, no person
will be "apioyed 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 Insuranu.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Tit
WORK NOTED
utyand fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED•IN BUILDINGS shall be coin.
ImOWledged in space provided,
pleted In six months.)
BIGNATUIII (OWNER Oa GENTTZ I DATE SIGNED
1 ��—J/
INSPECTION
DEPARTMENT
Dl OR -S BLGNAT (Ejf
l-!7• � �s f!'
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Vf ..&/l' t
NOTE: Atiplicart Subject to Plan Check Fee
CITY OF
EDMOND9
DATE
/ —
775-2525
This Permit cucero work to be done on private property ONLY.
Any Mnetrurtlan on the 1mb11c damn]. (curb-. sidewalk;, driveway.,
FILE
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