740319.pdfPERMIT APPLICATION I Insldo Heavy Lines
NAME (OR NAME OF BUSINESS) V
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MAILING ADDREyBB /�
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CITY 7
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NAME
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ADDRESS
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ADDRESS A 7 �L�/'41 14, A—
PERMISSIBLE 7 /ACTUA
LOT COVERAGE LOT COVER%
AGE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
❑ YE9 ❑ NO PERMIT NUMBER
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PERC. TEST
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I PERMIT NUMBER C
PLANNING DEPT. APPROVAL
DATE:
CITY
3, PROPOSED USE
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TELEPHONE NUMBER
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STREET R/W
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REMARxs
EXISTING STREET R/W ....... _... FT. DISFICIENUTHI
PROPERTY .
A 74 40
NAME
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SIGN
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FIRE ZONE
TYPE OF CONSTR ION STREET IMPROVED
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SWIMMING POOL
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� ECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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DEMOLITION
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CITY
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TELEPHONE NUMBER14
EXCAVATION OR FILL
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METER SIZE
SERVICE SIZE
CLEARANCE
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STATE LICENSE NUMBER
ADD
CITY LICENSE NUMBER
RETAINING
ARxB
formation given is correct; and that I am the owner, or the duly author-
❑ DEMOLISH
❑
WALL
ATTENTION
APPLICATION APPROVAL
EXCAVATE
Will be employed In Violation of the Labor Code of the elate of Washington
THIS PERMIT
//
REMARHdr
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G 94ALES S r 100 Fr S of
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PERC. TEST
BUILDING
I PERMIT NUMBER C
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3, PROPOSED USE
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REMARxs
A 74 40
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SIGN
AG G
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FIRE ZONE
TYPE OF CONSTR ION STREET IMPROVED
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SWIMMING POOL
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� ECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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DEMOLITION
❑ RESIDENTIAL
GAS
❑ YES
19 � /
NEW
EXCAVATION OR FILL
LINE
PLA cHEcxE
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THIS SITE IS LOCATED IN THE CITY
® NON-RESIDENTIAL
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TOTAL AMOUNT DUEO
OF EDMONDS. LOCAL SALES TAX
HOULD BE CODED 31.04.
6,
ADD
I hereby acknowledg. that I have read this appllcation: that the In-
RETAINING
ARxB
formation given is correct; and that I am the owner, or the duly author-
❑ DEMOLISH
❑
WALL
ATTENTION
APPLICATION APPROVAL
EXCAVATE
Will be employed In Violation of the Labor Code of the elate of Washington
THIS PERMIT
//
relating to Workmen's Compensation Insurance.
7
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signed by the Building Official or his Dep -
ALTER F-1FILL
❑
`ENCZ..........IH.J
shall be completed in ninety days: MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
❑
REPAIR ❑OR
NSP.
O
SWIM
POOL/N,jl
�C/
INSPECTION
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NUafBER OF BTORI F.S NUMBER OF
DEPARTMENT
S - 2 9- 7y
CITY OF
DWELLING
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
UNITS
775-2828
This Perinit carers work to be dopa on private property ONLY.
NATURE OF WORK TO BE DONE
Ao)• ronsinwllen nn Ihr pablle d.m.ln (curb., dr] -way-,
FILE
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Vnivatlon Fee Receipt No.
N sL
Plan Cheek No. ....................
BUILDING
(O(�
3, PROPOSED USE
y
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting street.)
HEAT d: GAS LINE
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FENCE
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SIGN
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RETAINING WALL
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SWIMMING POOL
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUEO
F
6,
I hereby acknowledg. that I have read this appllcation: that the In-
formation given is correct; and that I am the owner, or the duly author-
Ired agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
leting construction; and In doing the work authorized thereby, no person
Will be employed In Violation of the Labor Code of the elate of Washington
THIS PERMIT
This application is not a perinit until
relating to Workmen's Compensation Insurance.
AVTIIORIZE8
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONN 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 com-
knowledged in space provided.
pletcd In six months.)
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
1jiE OR' a NATU
DEPARTMENT
S - 2 9- 7y
CITY OF
1
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
tj67 4
775-2828
This Perinit carers work to be dopa on private property ONLY.
Ao)• ronsinwllen nn Ihr pablle d.m.ln (curb., dr] -way-,
FILE
vyi�i., e, rtr.� "III rl litre nrl�.r.lr f+'rmle elan.
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