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STATE LICENSE NUMBE
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BUILDING DEPARTMENT Appucant Flu
PERMIT APPLICATION I Eagldo Heavy Lines
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ADDRESS
NAME
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LOT COVERAGE LOT COVERAGE
LEGAL LOT VARIANCE OR CONDITIONALUSE
YES [3 NO PERMIT NUMBER
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PERMISSIBLE ItleIBLE HEIGHT PROPOSED HEIGHT
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TELEPHONE NUMBER
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ACTUAL LOT AREA 'TOTAL BLDG. AREA
NAME
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STATE LICENSE NUMBE
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REQUIRED YARDS PROPOSED YAItOH
FRONT SIDE REAR FRONT SIDE REAR
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NAME
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LEGAL LOT VARIANCE OR CONDITIONALUSE
YES [3 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
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TELEPHONE NUMBER
STREET It
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
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NAME
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REMARKS
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REMARKS
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TELEPHONE NUMBER
METER BILE SERVICE SIZE
CLEARANCF.
CHECKED BY
STATE LICENSE NUMBE
111Y LICENSE NUMBEH
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REMARKS
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Legal Description of Property Iehaw Below or Attach Your Copies)
TYPE CONNECTION
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PERO. TEST
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PERMIT NUMBERtz
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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E)YES I7 NO I
ePECIAL INSPECTOR REQUIRED
❑ YES NO
OCCUPANCY GROUP
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RESIDENTIAL LINE
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PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
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OF EDMONDS. LOCAL SALES TAX i
❑ nnn RETAINING
REMARKS
SHOULD BE CODED 31.04.
❑ DF,MOLSex ❑ WALL
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ALTER EXCAVATEFENCE
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❑ OR FULL x .......... Ft.)
❑ REPAIR PRE-❑ swim
SP. ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
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UNITB
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Vnluallon Fee Recclpt NO. i
NATURE OF WORK TO BE DONE
Plan Check No ............ .........
BUILDING
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PLUMBING
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HEAT & 6A9 LINE
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� PLOT PLAN (InUknte Building setbacks, abutting streets)
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SIGN
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
ricihereby
TOTAL AMOUNT DUE
ncknawtedsn that I have road 161s apPilentlon; that the ln-
formation Riven Is correct; and that I "'the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws rogu-
ATTENTION
APPLICATION APPROVAL
and
IaUng construction; and In doing the work authorized thereby, no person
will be employed In of the Labor Cade 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 THE
WORK NOTEB
uty; and fees are paid, and receipt is ac -
.hall be completed to ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged in space provided.
pteted in six menthe.)
INSPECTION
DEPARTMENT
DI TOR'S 8 ATU / _
/ _-/
SIGN TURE (OWNER OH AGENof
T - DATE 016NED
CITY OF
EDILIONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775.2525
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This Perntlt Covera work to be done on private property ONLY.
Any—strucllan on the public domain (curb., .Idcwalk., drh•eways.
FILE
marquee., ele.) will r"ulre separate permission.
USE
! BUILDING DEPARTMENT Applicant Fill ZONE NUMBER
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PERMIT APPLICATION I IBStdo heavy Linos ion
ADDRESS
NAME'IOI�NAMBUSINESS)
/ - P911MIHHIUL ^e ACTUAL
{ , y I J ) /A,LOT COVERAGE LOT CDVESRAOE
A LI O DURESS .t ��.� -1 PERItItltlIBLE HEIGHT PROPOSED HEIGHT O ��
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// r % � S V �jACl'UAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
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FRONT SIDE. REAR FRONT SIDE REAR 1 y
LEGAL LOT VARIANCE OR CONDITIONAL UBE
C3 YES IJ NO PERMIT NUMBER ;
PLANNING DEPT. APPROVAL DATE:
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STREET R/W O
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY ..
COMP. PLAN ST. R/W ............FT: ............IT.
REMARKS
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BUILDING
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PLUMBING
CHECKED BY
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TEEPHONE NUMER
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PLOT PLAN (InUIC[�lfo ,i*gMg.b t uck.. abutting streets)
HEAT A GAS LINE
METER BILE SERVICE SIZE
CLEARANCE
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CHECKED BY
TATE LICENSE NU .
CITY LICENHE NUMBER
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FENCE
BION
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WALL
REMARK
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egal Description or Property (Show Below or Attach Four Copies)
SWIMMING POOL
TYPE CONNECTION
VERIFIED BY
'
Et ED NUI ER
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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TOTAL AMOUNT DUE
C3 YES []NO
I hereby acknowledge that I have read this application; that tha In•
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
formation given le correct: and that I am the owner, or the duly author-
�REHIDENTIAL
❑
GAS
❑ YES L] NO
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ATTENTION
NEW
{�
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
relating to Workmen's Compensation Ie,uranes.
AUTHORIZES
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NON-RESIDENTIAL
❑
SIGN
shall be completed In ninety days; MOVED -IN BUILDINGS shall be Som-
OF EDMONDS. LOCAL SALES TAX
knowledged in space provided.
ADD
SIGNATURE (OWNER OR AGENT) I DATE BI NNED
RETAINING
REMARKS
SHOULD eE CODED 31.04.
fir/[_ )i?/;vf
DEMOLISH
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WALL
EDMONDB
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NOTE: Applicant Subject to Plan Check Fre
ALTER
S (l
EXCAVATE
❑
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, rte.) .•111 reyulm separate pe+mieelon.
- INSPECTOR' /
❑
OR FULL
(ENCx.......... Vt.)
REPAIR
❑
O
POOL
INABEPbIOVE
7UMBER OF STORIES NUMBER OF
DWELLING
UNITS
Plan Check No .....................
BUILDING
S PROPOSED USE
p•I,
PLUMBING
PLOT PLAN (InUIC[�lfo ,i*gMg.b t uck.. abutting streets)
HEAT A GAS LINE
R
FENCE
BION
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that tha In•
formation given le correct: and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
luting construction: and In doing the work authorized thereby, no person
will be employed In vinlatlOn of .1 Labor Code of the Stale of Washington
THUS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Ie,uranes.
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 days; MOVED -IN BUILDINGS shall be Som-
knowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT) I DATE BI NNED
INSPECTION
DEPARTMENT
Dl TOR'S ONAT
BI
fir/[_ )i?/;vf
CITY OF
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EDMONDB
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NOTE: Applicant Subject to Plan Check Fre
775-2525
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This Per It encs¢ work to he done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, rte.) .•111 reyulm separate pe+mieelon.
- INSPECTOR' /