740544.pdfI
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USE reualsETR 7/40544
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BUILDING DEPARTMENT Applicant FillZONE
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PERMIT APPLICATION
ADDRE8H 99_
NAME
(OR NAME OF BUSINESS)
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PERMISSIBLE � ACTUAL 1
LOT COVERAGE rhe LOT COVAAGE D(�,
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ADDREBB
PERMISSIBLE HEIGHT PROPOSED H� �T a
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TELEPHONE NUMBER
ACTUAL LOT A EA TOTAL BLDG. EA
CITY
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CIRCA,i,>�l
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EQUIRND YARDS PROPOSED YARDS
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NAME
FRONT BION REAR FRONT SIDE REAR
�5� io ( �-st 30-
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LE Al. LOT VARIANCF. OR CONDITIONAL USE
UU7 ADDRESS
j1YES (] NO PERMIT NUMBER
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PLANNING D PT. PPROVAL TE)
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r� CITY
TELEPHONE NUMBER
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STREETR/W n O
EXISTING STREET R/Wt'.. .........FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/Wr.��.%....Fr. ........ .FT. N
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Il w ' ^r1A:rkt `t?C;yA ti la r•wtt
REM"' "Driveway sbope not to exceed those o
ADDR. e
indicatisd nn Uandard Drawing
#143" w
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CHECKED BY
OTTY TELEPHONE SUNDER
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�N TT/.A L ? 1-L L--1• I F�u tC �> o �C �'
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MET 1 SIZE SERVICE CLEARANCE
CHEjI ED BY
STATE LICENB NULSBER CITY LICENSE NUMBEK
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REMA S
SLegal tCrty ow Below or Attach Four Copies)
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TYPE CONNECTION
VERI ED BY
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FERC. TEST
PERa N MBER y.
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REMARKS
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1,11NE:j TYPE OF CONBTAUCTION BTREE� IMPROVED
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SPECIAL INBPECTOR OUIRED OTCCUPANCY GROUP
RESIDENTIAL
❑ CAB
LINE
❑ YE0 ..±
®' NEW
PLA CKED Y THIS SITE IS LOCATED IN THE CITY
_
NON-RESIDENTIAL
BICTN
OF EDMONDS. LOCAL SALES TAX
ADD
REAINING
AI RK/'� 5HOULD/8E CODED 3L04.
DEMOLISH WALL
❑
FENCE
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0 ALTER ❑ EXCAVATE
OR FILL (..........x .......... Ft.)
❑ REPAIR ❑ PRE-INSP. O POOL{
NUMBER OF STORIES NULSBER OF
)
DWELLING
-� UNITS `
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
Plan Check No .....................
BUILDING
P„
Gd/D
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[may
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PROPOSED USE
PLUMBING
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HEAT & GAS LINE
QS��
O
EPLOT
PLAN (Indicate Building setbacks, abutting Street.)
31
FENCE
SIGN
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tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In-
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formation given " correct; and that I a n the owner, or the duly author-
Med agent of the owner. I agree to comply with city and .late law. regu.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no parson
will be employed In Violation of the Labor Code of the Stale of Weehingloa
THIS PERMIT
This application is not a permit until
relatlog to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIM
WORK NOTED
uty; and fees are paid, and, receipt is Be
shall be completed In ninety days; MOVED -IN BUILDINGS shall be coca.
edged in Bp vlded,
pictcd In six month'.)
BI
N TU1tFt (OWNER OR AGENT)
DATE SIGNED
INSPECTION
1RECT R'S B A RE
)
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DEPARTMENT
CITY OF
124-1-4
EDMONDS
UAM I
NOTE: Applicant Subject to Plan Check Fee
n
0
775-2525
This 1'erwit Cl— work to be done on Drlvale properly ONLY.
Any con.lrucllon on the public domain (curbs, eIde.suk., 111—aY.,
FILE
nterqueee, etc.) will require separate permission.