740499.pdf4
BUILDING DEPARTMENT Applicant Fin ZONE NUMBER 740499
PERMIT APPLICATION Ins,de Leavy I Ines
NAME (OR NAME OF BUSINESS)
�/ � M ICING D R SS
TELEPHONE NUMBER
S
AME
(�d ADDRESS
F
JOB
ADDRESS 73 I/y-
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PERMI..IBLE
LOT COVERAGE
LOUT' COVERAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
AEQVIRED YARDS
TOTAL BLDG. AREA
PROPOSED YARDS
FRONT BIDE REAR
FRONT BIDE REAR
CITY TELEPHONE NUMBER
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES 0 NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL
DATE:
CITY TELEPHONE NUMBER
STREET R/LV
EXISTING STREET R/W
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............FT. DEFICIENCY THIS PROPERTY
NAME
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COM7F. PLAN ST. R/W
............FT. ............FT.
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REMARKS
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C
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TEL�EJP{�H/./ONE NUMBER
CHECKED
CHECKED BY
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METER BILL
BhRVICE 812E
CLEARANCE
CHECKED BY
9T LICENSE NUMBER
ITY LICENSE NUMBER
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Legal Description at Property
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE
TYPE OF
CONSTRUCTION STREET IMPROVED
0 YES 0 NO
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SPECIAL INSPECTOR
REQUIRED GROUP
RESIDENTIAL
GAB
0
0 YES 0 NO
(OCCUPANCY
NEW
LINE
PLAN CHECKED DY
THIS SITE IS LOCATED IN THE
NON-RESIDENTIAL
s1aN
CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD
ADD
RETAINING
REMARKS
BE CODED 31.04.
DDEMOLISH D WALL
El ALTER EXCAVATE FENCE
,
❑ OR FILL( ..........x._.......Ft.)
REPAIR PRE -MOVE SWIM
INSP. POOL
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NUMBER OF STORIES NUMBER OF
V
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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L7 7- J
Fcc Receipt No.
Plan Check N. .....................
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BUILDING
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PROPOSED UBE
PLUMBING
PLOT PLAN (Intllcalo Bulldin6 Setbacks, nbuttln6 Streets)
HEAT A GAS LINE
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O O
FENCE
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SIGN
tRETAINING
WALL
-
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
I hereby acknowledge that I have read this appllcnllon; that the In.
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TOTAL AMOUNT DUE
formation given Is cermet: and that I = the oweer, or the duly author-
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(zed agent of the owner. I agree to comply with city and state laws reg.-
lotting conetrUCtIon; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
W.I. be employed In violation of the Lahor Code of the State or Washington
T
THIS PERMIT
relating to Wo en's Compensation Insurance.
This application is not a permit until
AUTHORIZER
ONLY
signed by the Building Official or his Dep--
erm Limit One Year (Except DEMOLITIONS which
shall in
TILE
WORE NOTED
Uty; and fees are paid, and receipt Is ac -
a mplete sleety days; MOVED -IN BUILDINGS shall be Som.
plot 1 eI. mo the.)
knowledged 1n space provided.
SIG AT RE ( tV R OR AGENT' DATE dIONED
INSPECTION
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DEPARTMENT
Dl TOR'S d NAT
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CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan CGeck Fee
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775-2525
This Permit curers work to he done on Private property ONLY.
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Any con Strachan on the public donmin Icurhs, eldewalks, driveways,
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