740585.pdfPlan Check N. .....................
USE PERMIT 7��J5
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BUILDING DEPARTMENT
Applicant Flll
NUMBER
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PERMIT APPLICATION
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PLUMBING
ADDRESS �%
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NAME (OR NAME OF BUSINESS)
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E PLOT PLAN (Indicate Building setbacks• abutting street.)
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HEAT A GAS LINE
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PF.RMISBIHLE ACTUAL q
LOT COVERAGE
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FENCE
IAT COVERAGE
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SIGN
MAILING ADDRESS
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITY
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TELE PHO
ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROPOSED YARDS
DEMOLITION
NAME
FRONT HIDE REAR FRONT SIDE REAR
PRE -MOVE INSPECTION
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FY
EXCAVATION OR FILL
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AL LOT VARIANCE OR CONDITIONAL USE
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NO
YPERMIT NUMBER
TOTAL AMOUNT DUE
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PLANNING DEPT. AL DATE:
I hereby acknowledge that I have read this application; that the In.
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CITY ITELEPHONE
NUMBER
formation given le correct; and that I ant the owner• or the duly author-
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tzed agent of the owner. I agree to comply with city and elate law. regu.
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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lating construction; and In doing the work authorized thereby, no person
NAME • / �
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COMP. PLAN ST. R/W ............Ff. ............FT,
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REMARKS
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ADDRE
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
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T 1 O —•
CITY
TELEPHONE NUMBER
shall 6e completed In nlostY days; MOVED -IN BUILDINGS shall be wm-
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DATE SIGNED
INSPECTION
1REC BIO RE
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METER SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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TE
NOTE: Applicant Subject to Plan Check Fee
775-2525
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This i•ermit coven work to be done on private property ONLY.
Legal Description of Property (Show Below ar Attach Four Copies)
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TYPE CNNECTION VERIFIED BY
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PERC. TEST PERMIT NUMBER
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REMARKS
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to
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIREDOCCUPANCY GROUP
RESIDENTIAL
OAS
❑ YES �it7/
NEW
LINE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
Of EDMONDS. LOCAL SALES TAX
SIGN
,.ULD BE CODED 31.04.
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RETAINING
WALL
ARK
DEMOLISH
ALTER ❑ ORFILLEXCAVATE
❑ FENCE
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--MOVE
REPAIR ❑ INSP.
El SWIM
POOL
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N U.IHER OF STORIES NUB
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UNIT
Plan Check N. .....................
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BUILDING
I
[O
C PROPOSED USE
PLUMBING
W
E PLOT PLAN (Indicate Building setbacks• abutting street.)
7
HEAT A GAS LINE
FENCE
1 i
SIGN
Y '
RETAINING WALL
—
BWIMMIN6 POOL
t{t{
DEMOLITION
PRE -MOVE INSPECTION
FY
EXCAVATION OR FILL
8
t
4
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given le correct; and that I ant the owner• or the duly author-
tzed agent of the owner. I agree to comply with city and elate law. regu.
ATTENTION
APPLICATION APPROVAL
lating construction; 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 Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
d fees are paid, and receipt is ac-
uty anp
shall 6e completed In nlostY days; MOVED -IN BUILDINGS shall be wm-
WORK NOTED
knowledged in s ace provided.
ptetcd In .1. months.)
IGNATURE (OWNER OR�6E2jT)
DATE SIGNED
INSPECTION
1REC BIO RE
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DEPARTMENT
I
CITY OF
EDMUNDS
TE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This i•ermit coven work to be done on private property ONLY.
Any rnn.t—tion an it,, public dmmln (rnrhe, .Idrw•nik., drlvew'nys'
FILE
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