740537.pdfBUILDING
DEPARTMENT
Applicant Fill
ZONE r - I pl NUMBER
PERMIT APPLICATION
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ADDRESS G (� SKyU,uC R t
NAME (OR NAME OF BUSINESS)
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL LDOa.
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HEAT ar GAS LINE
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SPECIAL INSPECTOR REQUIRED
REQUIRED YARDS YARDS
FRONT BIDE REAR O�'T SIDE REAR
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USE
PLOT PLAN (Indicate Building setbacks, abutting streets)
NAME
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ADDRESS
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GAL LOT VARIANCE OR CONDITIONAL
EO YES [J NO PERMIT NUMBER
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RESIDENTIAL
NON -RESIDE
DEMOLIeIi
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REMARHH Driveway slopes not to exceed those
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DEMOLITION
indicated on Standard Dwg. No.103
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SITAT77E LICENSE NUA1BER
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formation given Is correct; and that I am the owner, or the duly author-
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RE/MARKS
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APPLICATION APPROVAL
Leg nl De Ip(lon of Property (Show BcloW or A tach Faur
eating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
/CoDlee)
TYPE CONNECTION
AIFI� Y
AUTHORIZES
signed by the Building Official or his Dep-
I
NOTE: Permit Limit One Year (Except DEMOLITION'S which
ONLY THE
WORK NOTED
Vill:
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shotl be completed In ninety day.; MOVED -IN BUILDINGS shall be corn-
1�.
pleted In .Ix months.)
PERC. TEST
P R I NU BER
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IE(O Et<R A¢ENT)
DATE SIGNED
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SIONA URE
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REMARKS '�
W
NATURE OF WORK TO BE DONE
Vniunllon
Fee Receipt No.
Plan Check N. .....................
FIRE/ZOjIyE
TYPE OFrTRu, 11 STREET IMPROVED
PROPOSED USE
PLUMBING
% (�
I _ YES rJ NO
HEAT ar GAS LINE
SPECIAL INSPECTOR REQUIRED
OCCUPANCY OR UP
PLOT PLAN (Indicate Building setbacks, abutting streets)
FENCE
(] YES
,Q NO
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NF.tV
ADD
LJALTER
im
❑
RESIDENTIAL
NON -RESIDE
DEMOLIeIi
EXCAVATE
OR FILL
❑
❑
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OAS
LINE
SIGN
RETAINING NING
FENCE
.......... . .......... Ft.)
PLAN CHECKED
DY THIS SITE IS LOCA ED IN THE CI Y
EDMONDS. LOCAL SALES TAX
S0,'0ULD BE CODED 31.04.
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SPAtOVE
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POOL
7Ua[BER OF 6TOIitES
I NUMBER OF
DEMOLITION
NATURE OF WORK TO BE DONE
Vniunllon
Fee Receipt No.
Plan Check N. .....................
BUILDING
PROPOSED USE
PLUMBING
1/ .
HEAT ar GAS LINE
PLOT PLAN (Indicate Building setbacks, abutting streets)
FENCE
SIGN
tRETAINING
WALL
-
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DILE
I hereby acknowledge that I have read this application; that the in.
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formation given Is correct; and that I am the owner, or the duly author-
-
Ized agent of the owner. I agree to comply with city and elate law. mgu-
ATTENTION
APPLICATION APPROVAL
eating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
I
NOTE: Permit Limit One Year (Except DEMOLITION'S which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
--.
shotl be completed In ninety day.; MOVED -IN BUILDINGS shall be corn-
knowledged in S ace provided.
pleted In .Ix months.)
IE(O Et<R A¢ENT)
DATE SIGNED
INSCTION
SIONA URE
VDEPARTMENT/ //
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CITY OF
Fee
EDMONDS
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NOTE: Applicant Subject to Plan Check
775-2525
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This Permit coven trork to be done on private property ONLY.
Any construct Lon on the Public domain (curb.• sidewalk., drivew.y.,
FILE
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