740599.pdfBUILDING DEPARTMENT I Appllcnnt FIII ZONE NUMBER
740599 }
JOB
PERMIT APPLICATION
Inside Heavy Lined
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LOT COVERAGES 3 5 �
ACTUAL
LOT COVERAGE DIC
NAME (OR NS�E OF BUBINEdB)
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CITY TELEPHONE NUMBER
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TELEPHONE NUM—BIERR
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NAME
FRONT SIDE REAR
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ADDRESS
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LOT COVERAGES 3 5 �
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CITY TELEPHONE NUMBER
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PR OPOSE YARDS
FRONT SIDE REAR
FRONT BIDE REAR
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LEGAL LOT VARIANCE
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00 YES [] NO PERMIT NUMBER
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PLA NI O EP APPRO AL A E:
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CITY TELEPHONE NUMBER
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STREET R/W
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EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
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NAME - ..
COMP. PLAN 8T. R/W ............FT.
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REMARKS
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ADDRESS
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TEL'E'1PHONQE NUM—BIER
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METER SIZE SERVICE SIZE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER`/
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
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PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF
CONSTRUCTION STREET IMPROVED
YES L] NO
SPECIAL INSPECTOR REQUIRED
GROUP
® RESIDENTIAL
YES
IOCCUPANCY
❑ LINE
❑ NE{V
PLAN CHECKED BY Y
THIS SITE IS ED LOCATIN THE CITY
NON-RESIDENTIAL SIGN
5ALE5 TAX
0HOULD
ADD RETAINING
REMARKS
BE CODED 31.04IOCAL
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❑ DEMOLISH ❑
ALTER EXCAVATE FENCE
OR FILL C.........X..........Ft.)PRE-
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swim
E] REPAIR ❑ INSPASOVE El POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
V¢luatlon
Fee Receipt No.
Plan Check Na.
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BUILDING
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PROPOSED USE
UPLUMBING
PLOT PLAN (Indicate BWhiles estatch.. abutting streets)
HEAT A, OAS LINE
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FENCE
SIGN
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RETAINING WALL
eWIaiMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this aDDllcatlon; that the In-
formation given Is correct; and that 18rn the owner, or the duly author-
Ized agent of the owner. 1 agree in coply with ally and erste laws raga-
ATTENTION
APPLICATION APPROVAL
toting conslructlod; end In doing the work authorized thereby, n¢ person
will be employed In violation of the Labor Code of the State of Washington
THIS I-ER511T
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 TIIE
WORK NOTED
uty; and fees are paid, and receipt is ac -
,hall be completed In ninety days; MOVED -IN BUILDINOS shall be corn-
knowledged in space provided.
pleted In six months.)
SIGNAT E (OWNER OR AGENT) DATE SIGNED
INSPECTION
IR O SIGN TUR
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DEPARTMENT
CITY OF
EDMONDS
ATE
NOTE: Applicant Ssl.'rct 1G Plan Cbrck Fce
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This Perndl covers work to to, done a n private property ONLY.
775-2525
Any '..."U 111- on the public domain (curbs, eldewWks, drive.".,
ruarqueee, etc.) wtll require Separate nerndeelon.
FILE
ALTER
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17 REPAIR
❑
BUILDING
AppUcsnt FW ZONE t � NUMBER
DEPARTMENT 1 - r ("
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NUMBER OF
PERMIT APPLICATION I Inside heavy Lines JO,,
ADDRESSC1
x
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DWELLING
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NAME (Oft NAME OF BUSINESS) •�1,'X f�i� � 3 !' I�JJ 1'. ��`-
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t :, 1• �..J ' I l C ti• LOT COVERAGE LOT COVEtYAGE
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MA LINO A DRESS yEIOIiT
PEIty11StlI8LE HEtO)IT PROPOSED ;,I
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CITY
TELEPHONE NUMBER ACTUAL LOT AREA TOTALI L. 6.
C&HPA
-/ _r —' y fi' r itEQU1RED YARDS PROPOSED YARDS
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NAME FRONT HIDE REAR FRONT SIUE REAR
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LE AL LOT VAHIANCE Olt CON ITI)NAL USE
ADDRESS Q YES [I NO PERMIT NUMBER
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DEPTH APP
PLANNIr ROVAL ,4 DATE:
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CITY I TELEPHONE NUMBER fI d
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME '�� ............FT.
ST. R/W ............FT.
A REMARKS
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L. I / C PLAN
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ADDRESS .,
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CHECKED BY
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CITYL :
TELEP/N'E NUMBER
RETAINING WALL
�H7O / '7 - ) /, Q METE"IZE I SERVICE SIZE CLEARANCE
ISWIMMING
CHECKED BY
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STATE LICENSE NUMBER CITY LICENSE NUMBER /' I� I
ail ';
DEMOLITION
J.•1I
RE/ Ji
PRE -MOVE INSPECTION
Legal Description of Property (Show Below Or Attach Your Copies) ;) J J
TYPE .CO EC 1 ERlFIED BY
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PERC. TEST P R UM
a
TOTAL AMOUNT DUE
REMARKS
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I hereby acknowledge that I have read this application; that the In.
i
formation given Is correct; and that I am the owner, or the duly author.
i
f ;
FIRE ZONE TYPE OF CONSTRUCTION ETRE T IMPROVED
�ES
I
Ized agent of the owner. I agree to comply with city and elate laws regu-
0 0 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
I
GASRESIDENTIAL E] ❑PLANSCHECKED
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
YO
LINE
New THIS SITE IS LOCATED IN THE CITY
-
releting to Workmen's Compensation Insurance.
Ej NON-RESIDENTIAL ❑ OF EDMONDS. LOCAL SALES TAX
Signed by the Building Official or his Dep -
SIGN SHOULD BE CODED 31.04.
ONLY TIRE
WORK NOTED
uty, and fees are paid, and receipt is ac -
E] ADD RETAINING REMARKS
WALL
El
shall be completed In ninety days; AIOVED-IN BUILDINGS shall be was-
DEMOLISH
FENCE
❑
ALTER
❑
OREXCAVPRE-ATE
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17 REPAIR
❑
INSPAIOVE
❑ POOL
IUMBER OF STORIES
NUMBER OF
x
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DWELLING
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BUILDING
r' ri U
UNITS
4
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Valuation
Fee
Receipt No,
Plan Check Na ........ _...... .....
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BUILDING
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PROPOSED USE
-
PLUMBING
aPLOT
PLAN (Indicate Bullding ojDjrke Cp 1 16..strcete)
HEAT & GAS LINE
O
�i
FENCE
SIGN
//
1 -fry-i C G:.l.il N
RETAINING WALL
ISWIMMING
POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
3(7
I hereby acknowledge that I have read this application; that the In.
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 laws regu-
latingconstruction; 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
releting to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS width
ONLY TIRE
WORK NOTED
uty, and fees are paid, and receipt is ac -
shall be completed In ninety days; AIOVED-IN BUILDINGS shall be was-
knowledged in Space provided.
plated In Six menthe.)
-
BIGNATURE (OWNER Olt AGENT) DATE SIGNED
INSPECTION
-...':TOR -8 B10NATURE.' �.
DEPARTMENT
CITY or
, -
EDIIIONDS
ATE
NOTE: Applicant S)tbiect to Pfaff Check Fee
775-2525
ThisPermit covers stork to be done on private property ONLY.
Any e ... I ..tied on th. public dams]. (curb., sidewalks, driveways,
INSPECTOR
marquees, etc.) will require separate permission.