740472.pdfi
USE PERMIT
BUILDING DEPARTMENT Applicant FillZO
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PERMIT APPLICATION Inaldo IieaYy Lines
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NAME (OR NAME OF BUSINESS)
PE 11 SIDLE me ACTUAL r
I.OT VO RAG LOT COVERAGE j
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ADD EBB
MAILINGPEN
PROPOSED HEIGHT O !
11tlSIHLE HEIGHT �
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CITY TELEPHONE NUMBER
ACT AL LOT AREA TOTAL BLDG. AREA > I
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REQUIRED YARDS PROPOSED YARDS
REAR
FIONT 8IDE REAR FRONT BIDE
NAME
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LE AL LOT VARIANCE OR CONDITIONAL USE
F ADDRESS
[ IES ❑ NO PERMIT NUMBER
_F_Lj NNING DEPT. VAL ATE•
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CITY TELEPHONE NUMBER
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EX STING STREET R/W ............FT. D CIENCY• THIS PROPERTY
NAME'
PLAN ST. R/W ............FT. .. .IT.
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CHECXED BY
CITY
TELEPHONE NUMBER
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ME II.It SIZE
SERVICE SIZE
CLEARANCE
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CITY LICENSE NUMBER
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RE RKS
Legal Description of Property (Show Below or Attach Four Capt..)
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VERIFIED BY
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PERMIV NUMBER
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REMARKS
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F1jlE 20NE TYPE OF CONST lON STREET IMPROVE
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`CIAL INSPECTOR QUIREDOCCUPANCY
GROUP
GAS
RESIDENTIAL LINE
❑ (YES
P[{AN CHECKED IIP
SITE IS LOCATED IN THE CITY
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THIS
EDMO TAX
❑ NON-RESIDENTIAL ❑ SON
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❑ ADD ❑ RETAINING
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❑ DEMOLISH
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❑ REPAIR ❑ INSPPRE-ASOVE ❑ POOLswiS
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE``II
Valuation
Fee Recetpt No.
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rum Check No.....................
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BI UILDING
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PLUMEING
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FAIENCE
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RETAINING WALL
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SWIMMING POOL
(DEMOLITION
TAE-MOVE INSPECTION
(EXCAVATION
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OR FILL
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,TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
formation given le correct; and that I am the owner, or She duly author-
leed agent of the owner. I agree to comply with city and state lawn rngu-
ATTENTION APPLICATION APPROVAL
laling construction; and In doing the work authorized thereby, no person
Willbe employed In violation of the Labor Code of the Biala of Washington
THIS PERMIT This application is not a permit until
relating to Workmen's Compensation Imurance.
AUTHORIZES signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DE51OLITIONS which
ONLY THE and fees are paid, and receipt is ac-
WORK NOTED Uty
shall be completed In ninety days; MOVED-IN BUILDINGS shall be com.
knowledged in space provided.
plc d In six month..)
B NA t • to
It AOE )
DATE SIGNED
INSPECTION DI R'S IONA URE
DEPARTMENT
CITY OF
DATE
Appfi t S.bi,,t to Plan Check Fee
p2 %
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NOT
775-2525
This Perri covers work to ba done on Pflvnte property ONLY.
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Any construction an the public domain (curbs,eldewniks, driveways,
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maa., etc.) 11111 reVW re scp_.Il perm(.ston.
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flan Check Nn .....................
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V -1-111.❑NO
NUMBER t
SPECIAL INSPECTOR REQUIRED
OCCUP U
❑ YES [3'NO
BUILDING DEPARTMENT
Applicant Fill
ONE
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PLAN CHECKED BY
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PERMIT APPLICATION
Inside Heavy Lines
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ADDRESS . ; �r
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NUMBER OF STORIES
NUMBER OF
"
NAME (OR NAME OF BUSINESS)
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PER 118SIBLE 7e ACTUAL
LOT COVERAGE - LOT COYEfiAOE
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PLOT PLAN (Indicate Building setbacks, abutting streets)
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Y
4'1_1
DWELLING
I���JP\
FENCE
IPIS 1 EBS
PERMISSIBLE HEIGHT PROPOSED It
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UNITS
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CITY, TELEPHONE
NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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,
Fee
Receipt I
II L i i• 1
/rC�— F��'CI , LS
REQUIRED YARDS PROPOSED YARDS
NAME
FRONT BIDE REARFRONT BIDE REAR
I.,
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SWIMMING POOL
f
LEGAL LOT VARIANCE OR CONDITIONAL USE
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A SS
YES , NO PERMIT NU,Di.
CITY TELEPHONE NUMBER
PLANNING DE T. PDAE;
P OVAL , / T
��
PRE -MOVE INSPECTION
,
STREET R/W U0
EXCAVATION OR FILL
-
EXISTING STREET R/W ............FT. D FICIENCY THIS PROPERTY
'y
NAME
COMP. PLAN BT. R/W ............FT. ............FT.
W�
TOTAL AMOUNT DUE
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REMARKS
I hereby acknowledge that I have rend this application; that the In-
C
ADDRESS
formation given iscorrect; and that I am the owner, or the duly author-
.
Ized agent of the owner. I agree to comply with city and state laws reg'-ers
CHECKED BY
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lilting construction; and In doing the work authorized thereby, no pon
eUe
C
CITY
TELEPHONE NUMBER
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Imuranu.
AUTHORIZES
signed by the Building Official or his Dep -
F
I
ONLY TILE
WORK NOTED
utyi and fees are paid, and receipt is ac -
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be Com-
linowledged in space provided.
pleted In six months,)
8
METER BILE
SERVICE SIZE CLEARANCE
C4ECKED BY
DIRECTORS SIONATURE
(/
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DEPARTMENT
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CITY OF
I I
NOTE: Applica'rit Subject to Plan Cbrck Fee
EDMOND$
ATT /
�1 �17 U
775-2525
This Permit c work to he done on private property ONLY.
Any Construction on lh. pub..0 domain (curb., sidewalks, drWeways,
marquees, etc,) will require separate permission.
REMARKS
Legal Description of Properly (Show Below or Attach Four Copies)
TYPE.CONNECTION VERIFIED BY
I
PERMI+ NUMBER
a
r i) f 1'✓ t 1
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aenlna i, ��.
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1✓/.��, /.: r- /, l-+ : //l.
flan Check Nn .....................
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V -1-111.❑NO
SPECIAL INSPECTOR REQUIRED
OCCUP U
❑ YES [3'NO
1_�
ElRESIDENTIAL GAS
❑ NEW ❑ LINE
❑ NON-RESIDENTIAL s:cN
❑
PLAN CHECKED BY
is 11�1r _-
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
❑
❑EXCAVATE
❑
ADD ❑
ALTER
REPAIR
❑
DEMOLISH
OR FILL
INSP. PRE -MOVE
INSP.
❑
❑
❑
RETAINING
WAIT'
FENCE
(.....................Pt.)
SWIM
POOL
POOL
HE ARKS
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NUMBER OF STORIES
NUMBER OF
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
/
DWELLING
I���JP\
FENCE
UNITS
,
NATURE OF WORK TO
BE DONE
SIGN
Valuation
Fee
Receipt I
RETAINING WALL
N
1✓/.��, /.: r- /, l-+ : //l.
flan Check Nn .....................
7.
BUILDING
[„'Jy,
0,
PROPOSED USE
a,
PLUMBING
Uq
w
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
/
I���JP\
FENCE
,
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
-
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In-
formation given iscorrect; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws reg'-ers
ATTENTION
APPLICATION APPROVAL
lilting construction; and In doing the work authorized thereby, no pon
Will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Imuranu.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
utyi and fees are paid, and receipt is ac -
shall be completed In ninety days; 31OVED-IN BUILDINGS shall be Com-
linowledged in space provided.
pleted In six months,)
SIGNATURE, (OWNER OR AGENT) DATE 816NED
INSPECTION
DIRECTORS SIONATURE
(/
I
DEPARTMENT
CITY OF
s -. ;�(+_q•_ ,/,:'/ -
NOTE: Applica'rit Subject to Plan Cbrck Fee
EDMOND$
ATT /
�1 �17 U
775-2525
This Permit c work to he done on private property ONLY.
Any Construction on lh. pub..0 domain (curb., sidewalks, drWeways,
INSPECTOR
marquees, etc,) will require separate permission.