740543.pdfi
USE n PERMIT 740543
NUMBER
BUILDING DEPARTMENT Applicant Fill
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PERMIT APPLICATION I Inside Heavy Lines
ADDRESS
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NAME (OR NAME OF HUSINE881
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t/411 17'1-111c_ ►-�,(;-/�/ I lr t%t
PERMISSIBLE ACTUAL %
LOT COVERAGE LOT COVE AGE
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MAILING ADDRESSO
PERbl)tltl7BLE HEI6�T PROPOSED HLIOpT
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ACTV�hO�APEA TOTAL�LL;6.��A
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7 REQUIRED YAItD9 PVVROP 9F.D YARDS -- p'
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NAME
FRONT HIDE REAR FRONT BIUE REAR_
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ADDRESS
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PLAN I O D T. AP ROVAL E'
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CITY
TELEPHONE NUMBER
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STREET R W
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STREET R/W DEFICIENCY THIS PRO ERTY
NAME
EXISTING ......�..I•'r.
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COMP. PLAN BT. R/W�.:. nFT. C.1 FT. W
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REMARKS "Driveway slope not to exceed those o
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ADDRESS
On Standard Drawing #103". w
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CHECKED BY
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TELEPHONE NUMBER
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MET F`R B}ZE SERVICF�/SIZE
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STATE LICF.NBII NVDSHER
CITY LICENSE NUMSER
I\CLEARANCE
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Legal Desarlpt al Propeow Below or Attach Fair ,Coplee)
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TYPE CONNECTION
VERIFI D Y
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR RUIRED OCCUPANCY GROUP
RESIDENTIAL
❑ GAS
LINE
❑ YES O I r`
NEW
PLAN CHECKED D THIS SITE 15 LOCATED IN THE CITY
NON-RESIDENTIAL
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OILOCAL SALES TAX
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ADD
RETAINING
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A HOULD BE CODED 31.04.
ElDEMOLISH WALL
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PENCE
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NUMBER OF STORIES NUMBER Or
DWELLING
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UNITS
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NATURE OF WORK TO HE DONE
Valuation
Fee Reeclpt No.
Plan Check No.....................
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BUILDING
34 61/1
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PROPOSED USE
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PLUMHIN6
PLOT PLAN (Indicate Building setback., abutting streets)
HEAT & GAB LINE
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PENCE
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SIGN
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WAL
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SWIMMING POO
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read thlc application; that the In-
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[orm¢tlon given Is correct: and that I am the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and elate law. regu-
ATTENTION
APPLICATION APPROVAL
lating eon.trucllon; and In doing the work authorized thereby, no person
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 I.11—ce.
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 Be-
shall be completed In ninety day.; MOVED-IN BUILDINGS shall be com-
wledged in Space provided.
pleted In six months.)
SIGNATURE (OWNER OR GENT) DATE SIGNED
INSPECTION
Dl R'S SIGN U
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DEPARTMENT
/
CITY OF
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This F-Init c vrn work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalk., dri—aze,
FILE
marquees, etc.) will r"Idre separate permission.
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