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b YES ❑ NO PERMIT NUMBER
PLAN NIprrj` PT. APPROVA �.1e _ � DATE:
IS
NUMBER �!"��
STREET H/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
O REMARKS
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0 YES [j NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
BUILDING DEPARTMENT
F LINE
❑PLANBCHECKED
I
CITY
AppllcantFtu
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PERMITR 740623
PERMIT APPLICATION
Inside Heavy Lines
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ADDRESS
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• (Oli NAME OF 8Ue1NE
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PERM i88151A
LOT COVERAGE
LOT CO
LOT VEAGE
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M LINO ADDR\E1S^Sr^\
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
TAR
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ACTUAL LOT AREA
TOTAL BLDG. AREA
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b YES ❑ NO PERMIT NUMBER
PLAN NIprrj` PT. APPROVA �.1e _ � DATE:
IS
NUMBER �!"��
STREET H/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W ............FT. ............FT.
O REMARKS
tom' IGT.
0 YES [j NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
F LINE
❑PLANBCHECKED
I
CITY
NEW
YO
THIS SITE IS LOCATED IN THE
TAX
No
s3aN
Of EDMONDS. LOCAL SALES
SHOULD BE CODED 31.04.
RETAINING
❑ ADD O WALL
REMARKSDEMOT
TAR
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ALTER ❑ ORCFILLE ❑ FEN Cx..........Fl.)
/`r•--/ (/
RE -MOVE O POOL
REPAIR INap
NUMEn OF STORIES NUMIIER OF
B
DWELLING
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UNITS
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NATURE '' WORK TO BE DONE t
Valuation
Fee R—IPt No.
Plan Check NO .....................
BUILDING
PR POSED U0
PLUMBING
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aPLOT PLAN (Indicate Building setbacka, abutting streets)
HEAT A GAS LINE
FENCE
BION
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
•'I d 9 /_ (1
I hereby acknowledge that I have read this application; that the In-
Y 7
tormation given Is correct: and that I am the owner, or the duly author-
Ired agent of the owner. 1 agree to comply with city and state Tawe resu-
ATTENTION
APPLICATION APPROVAL
toting constmetloa; and In doing the work authorised thereby no person
will be employed In violation of the Labor Code of the Slate 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 TitE
WORK NOTED
utyi fees are paid, and receipt is ac -
shall he completed In ninety days; MOVED -IN BUILDINGS shall be c nc-
jin ledg d in Space vided.
pleled In el% months.)
DATE SIGONCT
'e BI AT
�ATURE��)
_ 7' /
DEPARTMENT
CSL/
T
CITY OF
EDMOND
TE
ur
NOTE: Applicant Subject to Flan Check Fee
—� 30d
775-2525
77
r .7
This Permit coven work to be done on private property ONLY.
Any renet uetlnn On the Pnhlic domain (carbo, nldewalks, driveways'
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