740378.pdfSTATE LICENSE NU'IHER
LICENSE NUMBER
(CITY
_
Legal Description or Properly (Show Below or Attach Four Copies)
REMARKS
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BUILDING DEPARTMENT
ERMIT 740378
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NUMBER
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PERMIT APPLICATION
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MAILING ADDRESS
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REQUIRED YARDS PROPOSED YARDS
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SIGN
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NAME
FRONT BIDE REAR FRONT S1UE nEAR
REMARKS
BE CODED
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ALTER EXCAVATE F P�FEei�C�
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LEGAL LOT VARIANCE OR CONDITIONAL USE
REPAIR ❑ NBP. PRE -MOVE O swim
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NUlIBER Op` STORIES NUMBER OF
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CITY
TELEPHONE NUMBER
UNITS
STREET R/W
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NATURE OF WORK TO BE DONE
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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Valuation
Fee Receipt No.
NAME
1
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COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDRESS
70.
4 PI;OPOB' VBE
CITY
TELEPHONE NUMBER
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CHECKED BY
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Q PLOT PLAN (Indicate Buildinn�g 9yetbaeka, abutting etreeta)
HEAT & GAS LINE
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METER SIZE SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NU'IHER
LICENSE NUMBER
(CITY
_
Legal Description or Properly (Show Below or Attach Four Copies)
REMARKS
?
.I
i
VERIFIED BY
TYPE CONNECTION
1
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PERC. TESTPERMIT
NUMBER
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REMARKS
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FIRE 7rONE TYPE O
ONST^ C ION STREET IMPROVED
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\ E3 YES El NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GAS
❑
E]YESZiO
I
NEW
LSHOULD
LINE
PLAN CH CKED DY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
NON-RESIDENTIAL
SIGN
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31.04.
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❑ ADD
DEMOLISH O WEAIL.�L KING
REMARKS
BE CODED
ALTER EXCAVATE F P�FEei�C�
❑ OR FILL
REPAIR ❑ NBP. PRE -MOVE O swim
POOL
NUlIBER Op` STORIES NUMBER OF
DWELLING
UNITS
I
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
1
1;
Plan Check No .....................
,
BUILDING
4 PI;OPOB' VBE
1
PLUMBING
Q PLOT PLAN (Indicate Buildinn�g 9yetbaeka, abutting etreeta)
HEAT & GAS LINE
—
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
_
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby neknowledge that [have rend this aDplicntlan; that the In.
formation given Ie correct; and that I nm the owner, or the duly author.Ixed
agent of NO owner. I agree to Comply with elty and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed In A.I.11on of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compe... flea Insurem s.
AUTHORIZER
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 earn.
knowledged In space provided.
pleted In eta month'.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTO IO
DEPARTMENT
4A' -1;7'f
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775.2525
42
This Permit rorere work to be done on private property ONLY.
Any eane(ructlan on the public dameln (<urbe, eldewdke, d.11- ye,
moat urr,, elr.l will r" l" Separate prrml"Ion.
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