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LEGAL LOT VARIANCE OR CONDITIONAL USE
1 hereby acknowledge that I have read this application; that the In-
BUILDING
tormatlon given iscorrect; and that I nm the owner, or the duly author-
r
aUj ADDRESS
E3 YES [3 NO PERMIT NUMBER
lating construction; and In doing the work authorized thereby, no person
FENCE
will be employed In violation of the Labor Code of the State of Wasbington
SIGN
E+
RETAINING WALL
N
SWIMMING POOL
shall be camDlelad In ninety days; MOVED -IN BUILDINGS shall be com-
DEPT. APPROVAL DATE:
q'PLANNING
CITY
TELEPHONE NUMBER
STREET R/tV
O
1:1
❑
G
BIGN
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
b
�0.
fit
❑
DEMOLISH
NAME
BUILDING DEPARTMENT AppPERMT
( —/y
NUMBER741�3„PERMIT
EXCAVATE
OR FILL
IN P.PRE-
IrLt—YJ,YyA
❑
REMARKS
APPLICATION InsldoAD
'lADDRESSAM
IU1[BER OIC' 6TORIES
W
Any' rnn.Inlcilon an the public dontnln (rurba, nldewnikn, drlYmeaYa,
e
CHECK Y
IOR NAME OF BUSINESS)LOTCOoACTUALLOT
F+ CITY
TELEPHONE NUMDER
J-nZO
COVERAGE
LOTCOVEWAOE
METER SIZE
I SERVICE SIZE I CLEARANCE
I CID BY
MAILING ADDRESS
PEItAIItlSIIILE HEI63iT
PROPOSED HEIGHTCiT�
NACTUAL
LOT AREA
TOTAL BLDG. AREA
7
REMARKS
REQUIRED YARDS
PROPOSED YARDS
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7
U
W
O
LEGAL LOT VARIANCE OR CONDITIONAL USE
1 hereby acknowledge that I have read this application; that the In-
BUILDING
tormatlon given iscorrect; and that I nm the owner, or the duly author-
FIRE ZONE TYPE OF CONSTRUCTION STREE lnll'RUVED
,� ES ❑ NO
aUj ADDRESS
E3 YES [3 NO PERMIT NUMBER
lating construction; and In doing the work authorized thereby, no person
FENCE
will be employed In violation of the Labor Code of the State of Wasbington
SIGN
E+
RETAINING WALL
N
SWIMMING POOL
shall be camDlelad In ninety days; MOVED -IN BUILDINGS shall be com-
DEPT. APPROVAL DATE:
q'PLANNING
CITY
TELEPHONE NUMBER
STREET R/tV
O
1:1
❑
G
BIGN
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
b
�0.
fit
❑
DEMOLISH
NAME
� (
a�/j/ �j
I
O
❑
❑
EXCAVATE
OR FILL
IN P.PRE-
IrLt—YJ,YyA
❑
REMARKS
ADDRESS
attached.
IU1[BER OIC' 6TORIES
W
Any' rnn.Inlcilon an the public dontnln (rurba, nldewnikn, drlYmeaYa,
e
CHECK Y
F+ CITY
TELEPHONE NUMDER
_
f
METER SIZE
I SERVICE SIZE I CLEARANCE
I CID BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
�y
I
REMARKS
Lena! Deacrnd— of Property (Show Below
or Attach Four Covica)
r
I
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7
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[a
4 PROPOSED USE
D
aPLOT PLAN (Indicate Bull,
—
Plan Check No .....................
1 hereby acknowledge that I have read this application; that the In-
BUILDING
tormatlon given iscorrect; and that I nm the owner, or the duly author-
FIRE ZONE TYPE OF CONSTRUCTION STREE lnll'RUVED
,� ES ❑ NO
Ized agent of the owner. I agree to comply with city and state lawn regu-
HEAT d: GAS LINE
lating construction; and In doing the work authorized thereby, no person
FENCE
will be employed In violation of the Labor Code of the State of Wasbington
SIGN
SPECIAL INSPECTOR REQUIRED GROUP
RETAINING WALL
N
SWIMMING POOL
shall be camDlelad In ninety days; MOVED -IN BUILDINGS shall be com-
DEMOLITION
(OCCUPANCY
❑ YES I -,W, -•.J/
NEW
El
RESIDENTIAL
NON-RESIDENTIAL
1:1
❑
G
BIGN
PLAN PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
SH EDMINIIc LOCAL SALES TAX
SHOULD BE CODED 31.04.
❑ ADD
❑
DEMOLISH
RETAINING
REMARKS
Felice requirements - section 12.14.040
ALTER
REPAIR
❑
❑
EXCAVATE
OR FILL
IN P.PRE-
IrLt—YJ,YyA
❑
_.NC
4......._x..........Ft.)
"I”'
POOL
attached.
IU1[BER OIC' 6TORIES
NUMBER OF
Any' rnn.Inlcilon an the public dontnln (rurba, nldewnikn, drlYmeaYa,
�lll re....... ael+orale i,rrnd.alon.
DWELLING
UNITE
_
[a
4 PROPOSED USE
D
aPLOT PLAN (Indicate Bull,
—
Plan Check No .....................
1 hereby acknowledge that I have read this application; that the In-
BUILDING
tormatlon given iscorrect; and that I nm the owner, or the duly author-
PLUMBING
Ized agent of the owner. I agree to comply with city and state lawn regu-
HEAT d: GAS LINE
lating construction; and In doing the work authorized thereby, no person
FENCE
will be employed In violation of the Labor Code of the State of Wasbington
SIGN
relating to Workmen's Compensation Insurance.
RETAINING WALL
N
SWIMMING POOL
shall be camDlelad In ninety days; MOVED -IN BUILDINGS shall be com-
DEMOLITION
pleted In nix months.)
PRE -MOVE INSPECTION
HGNATURE (OWNER OR AGENT)
EXCAVATION OR FILL
Fee
—Ov
a I
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is aC-
)a1trW1_%iged jr-space provided.
FILE
TOTAL AMOUNT DUE .
1 hereby acknowledge that I have read this application; that the In-
tormatlon given iscorrect; and that I nm the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state lawn regu-
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Wasbington
THUS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
TUE
WORK NOTED
shall be camDlelad In ninety days; MOVED -IN BUILDINGS shall be com-
pleted In nix months.)
HGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
I
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775-2525
This l'erntitcneere work to be done on prirate property ONLY.
Any' rnn.Inlcilon an the public dontnln (rurba, nldewnikn, drlYmeaYa,
�lll re....... ael+orale i,rrnd.alon.
Fee
—Ov
a I
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is aC-
)a1trW1_%iged jr-space provided.
FILE