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BUILDING DEPARTMENT AppllcantF111 UN NEMER 7't�✓Z
PERMIT APPLICATION Inside Heavy Lines aoB
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NAME (OA NAME OF HUB1N BS) A.../ / ( L
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PERMISSIS E r ACTUAL J I_�
IAT COVERAGE LOT COVERAGE I
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SAILING ADDRLSfl PERMISSIBLE HEIGHT PROPOSED HEIGHT O �
LJ ,20/22-I.UCr'% 1
L`l��r� TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
NAME FRONT BIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE i
ADDRESS 0 YES NO PERMIT NUMBER
yO' PLANNING DEPT. APPROVAL ❑ATE:
E CITY TELEPHONE NUMBER''
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
/� ,�/�/' /'� COMP. PLAN ST. R/W ............FT. ............FT.
/� I 6 J l.J/AJ/✓� REMARKS y
m A eS O
N
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/C OCI�-iYC/l/9Q�G/6:�LJC G IL -O-' CHECKED BY
TELEPHON
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NUMDER
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/� METER BILE I SERVICE SIZE CLEARANCE CHECKED 13YV STATE LICENSE NUMBER CITY LICENSE NUMBER t[,m
REMARKS {�
Legal Description at Properly (Snow Below or Attach Four Copies) �
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TYPE CONNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
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WG REMARKS m
11
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FIRE ZONE I TYPE OF CONBTRUCTION STREET IMPROVED
YES 0 NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
GAS O YES (3 NO
RESIDENTIAL ❑ LSNE PLAN CHECKED BY
New THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIALOF EDMONDS. LOCAL
slcx SALES TAX
SHOULD BE CODED 31 04. i
❑ ADD ❑
DEMOLISH ❑ RETAINING REMARKS'1
WALL
02'
ALTER ❑ ORFILL
❑ FE ...... .......Ft.) '.
REPAIR PRE•a[OVE SWIM
INSP. POOL.
NUMBER OF BTOIiI ES NUMDER OF � I
DWELLING 1
UNITS
NATURE OF WORK TO DE DONE Valuation Fee Receipt No. i
--.—,_--, Plan Cheek No..„ ................. I
BUILDING
PROPOSED USE pLUMBINC
OU
PLOT PLAN (Indicate Bullding setback., abutting streets) HEAT A GAS LINE
FENCE i
SIGN 1
tRETAINING WALL }1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I
TOTAL AMOUNT DUE O I O O
I hereby acknowledge that I have rend this application; that the In. Q
formation given Ie correct; and that I am the owner, or the duly author•
Ized agent of the owner. I agree to ca
luting
with City and State laws resu•on ATTENTION APPLICATION APPROVAL
luting Construction; and In doing the work authorized thereby, no pers
Will be employed In violation of Ne Labor Code of the State of Waehlogton T1HS PERMIT This application is not a permit until s
relating to Workmen'a Compensation Insurance, AUTHORIZES signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Ezcept DEMOLITIONS which ONLY THE WORK NOTED Sty; and fees are paid, and receipt is ac -
ah gl be Z mpieted In ninety days; MOVED -IN BUILDINGS shall be win• knowledged in space provided.
plel ad In Ix month .)
S GN HE to N OR AGENT) DATE LGN t) INSPECTION
DEPARTMENT DI TOR'B IGNAT E
CITY OF tw
ED51ONDS nAF�
OTE: Applicant Subject to Plan Check ee --•
Tina Pe lnu rarer woru w be cane ¢ 775-2525
T = ----
n private property ONLY.
Any construction on Iha public domain (curbs, sidewalks, drivewys,
marquee., etc.) will require Separate perndsslon. FILE
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B U I L D I
NG DEPARTMENT Appncant Fill ZONE NUMBBER 7A D3Z7
PERMIT APPLICATION I Ineido Heavy Linos aoH
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ADDRESS _r-j—
ADDRESS
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CITY
NAME_
QC
ADDRESS
N CITY
t
N
I
REQUIRED YARDS PROPOSED YARDS
Valuation
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1
NEW
BUILDING
PLUMBING
ElNON-RE IDENTIAL
❑
BION
ADD
DEMOLISH
❑
NO
WALL
[D ALTER
❑ EXCAVATE
❑
FENCEx......._Ft.)
REPAIR
❑ INSPhfOVE
O
PWIM
OL
NUMBFI OF STORIES NUMBER OF
DEMOLITION
t
DWELLING
I
lang '*"'Motion; and In doing the work authorized thereby, no per linon
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
UNITS
THIS PERMIT
COMP, PLAN ST. R/W ............FT. ..........,.FT.
NATURE OF WORK TO DE DONE
AUTHORIZES
signed by the Building Official or his Dep.
REMARKS
ONLY THE
WORK NOTED
uty, and fees are paid, and receipt is aC-
.bell 'Io'oomplelcd In nlacty day@; hIOVED-IN BUILDINGS shall be com-
7.
O
pleted In els months.)
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1 CHECKED HY
W
INSPECTION
DEPARTMENT
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[7
L PROPOSED USE
CITY OF
EDMOND$
V
W
Applicant Subject to Plats Check Fce
a PLOT PLAN (Indicate Bullg_'�Zt aC(. ting
atresia)
9
D
Thin Permit coven work to be done an private property ONLY.
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N
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REQUIRED YARDS PROPOSED YARDS
Valuation
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1
FRONT BIDE REAR FRONT SIDE REAR
BUILDING
PLUMBING
r\) G+
!
LEGAL LOT ARIA CE OR CONDITIONAL USE
FENCE
o YES NO PERMIT NUMBER
SIGN
7v �/
I hereby acknowledge that I have read this application; that the In-
PLANNING DEPT. APPROVAL DATE:
G`/ • fl
SWIMMING POOL
DEMOLITION
t
STREET R/W
lang '*"'Motion; and In doing the work authorized thereby, no per linon
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
will be employ1d In vIol.1l.. of the Labor Code of the State of Washington
THIS PERMIT
COMP, PLAN ST. R/W ............FT. ..........,.FT.
ra
AUTHORIZES
signed by the Building Official or his Dep.
REMARKS
ONLY THE
WORK NOTED
uty, and fees are paid, and receipt is aC-
.bell 'Io'oomplelcd In nlacty day@; hIOVED-IN BUILDINGS shall be com-
O
pleted In els months.)
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1 CHECKED HY
W
INSPECTION
DEPARTMENT
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FIRE ZONE I TYPE OF
SPECIAL INSPECTOR RE
YES ❑ NO
OF EDMONDS.
m
STREET IMPROVED
0 YES ❑ NO
ROUP
TED IN THE CITY
)CAL SALES TAX
31.04.
Plan Check N . ................_...
Valuation
Fee Retelpt No.
BUILDING
PLUMBING
r\) G+
HEAT & GAB LINE
FENCE
TOTAL AMOUNT DUE
SIGN
7v �/
I hereby acknowledge that I have read this application; that the In-
RETAINING WALL
G`/ • fl
SWIMMING POOL
DEMOLITION
ATTENTION
-
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
7v �/
I hereby acknowledge that I have read this application; that the In-
G`/ • fl
formation given le correct; and that I a o the owner, or the duly author-
lzed agent of the owner. I agree to comply wtlh city and @tate lawn regu-
ATTENTION
APPLICATION APPROVAL
lang '*"'Motion; and In doing the work authorized thereby, no per linon
will be employ1d In vIol.1l.. of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relatlog to Workmen's Compeneatloa Iasurmu.
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-
.bell 'Io'oomplelcd In nlacty day@; hIOVED-IN BUILDINGS shall be com-
knowledged in space provided.
pleted In els months.)
SIGNATURE (O{ N lt OR AGENT) DATE SIGNED
.. ✓ ,, / / �
INSPECTION
DEPARTMENT
pI TOR'S S TU +a.
n
b
J �
CITY OF
EDMOND$
DATE
Applicant Subject to Plats Check Fce
NOTE:
775 -2525
-
Thin Permit coven work to be done an private property ONLY.
Any construction on the public domuin (curb., eldewdke, dr1'ewgs'
INSPECTOR
marquees. els.) will require neparale perml.elon.
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