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BUILDING DEPARTMENT I Applicant Fill ZONE C NUMBER 740346
PERMIT APPLICATION Inside Heavy Lines JOB I
S
NAME (OR NAME OF BUSINESS)
6
ADDRESS T
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ACTUAL'
llPERMl88IBLE ry L
U Y o>'{� $ LOT COVERAGE LOT COVESiAGE
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NO MAILIAD ESB .1I
2 NO S \� S 1 ' PERMISSIBLE HEIGHT PROPOSED HEIGHT
CITY '' `` TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
EElAtOtnc�S W -7 —1 G 1 7 REQUIRED YARDS PROPOSED YARDS
Legal Description of Properly (Show Below or Aileen Four Copies)
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TELEPHONE NUMBER
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EXI9 O STREET R/FR ..A... . DEFICIENCY THIS PROPERTY
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NAME
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FENCE
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ElEXCAVOR
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REMARKS
to exceed those
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ADDRESS
Driveway slopes not
indicated on Standard Dwg. No. 103
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CITY
NUMBER OF STORIES
TELEPHONE NUMBER
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PRE -MOVE INSPECTION
METER BILE I SERVICE SIZE I CLEARANCE
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ElEXCAVOR
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REPAIR
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NUMBER OF STORIES
NUMBER OF
SWIMMING POOL
DEMOLITION
DWELLING
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PRE -MOVE INSPECTION
EXCAVATION On FILL
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OF
UNITS
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IC..• .YES [I NO
OCCUPANCY GROUP
F - 7 -
IS SITE 15 LOCATED IN THE CITY
EDMONDS. LOCAL SALES TAX
)ULD BE CODED 31.04.
IT # -74th z Z.
K TO BE DONE
Valuallon
Foe Receipt No.
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Yinn Check No.... .................
BUILDING
[O
4 PROPOSED USE
PLUMBING N (�
aPLOT
PLAN (Indicate Building setbacks, abutting street.)
HEAT A OAS LINE
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7
FENCE
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SIGN
tRETAINING
WALL
-
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION On FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In.
formation given le correct; and that I a , the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lating eonetruction; and In doing the work authorized thereby, no parson
Will be employed In violation of the Labor Coda of the Stale of Washlbston
THIS PER511T
This application is not a permit until
.
relating to Workmen's Compensation Imuraics.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TitE
WOIIH NOTED
uty; and fees are paid, and receipt is ac
.hall be completed In nlnely days; MOVED -IN BUILDINGS shall be cum-
linowledged in space provided.
pleted etz mouth,.)
BIG URE (OWNER OR AO T)
DATE SIGNED
ED
INSPECTION
DIRECTO SIONATURE
DEPARTMENT
CITY OF
EDMOND9
DATE
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NOTE: Applicant Subject to Plan Check Fee
PR 5-1107
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This Permit covers work to be done on private property ONLY.
Any cnn•tnullon On It., publle d.maln (club., .14-1k,, drl—ej.,
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