740634.pdf1
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DEPARTMENT
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NUMBER 740634
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BUILDING AppLeaat FILL
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PERMIT APPLICATION
JOB
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ADDRESS
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NAME (OR E OF BUSINESS)
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PERMISSIBLE HEIOIST
PROPOSED HEIGHT
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TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG, AREA
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REQUIRED YARDS
PROPOSED VARUS
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NAME
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LEGAL LOT VARIAN E Olt CONDITIONAL USE
O YES 0 NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL
DATE:
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CITY
TELEPBONE NUMBER
STREET R/W
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EXISTING STREET RJW ............FT.
DEFICIENCY THIS PROPERTY
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COMP. PLAN 8T. RJW ..,.........FT.
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REMARKS
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CHECKED BY
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CITY
TELEPHONE NUMBER
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06 40
4816- S a6 Q
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METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUAI13ER
CITY LICENBE NUMBER
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REMARKS
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Legal Description of Property (Show Below or Attach Four Copies)
TY CONNEC ONVERIFIED
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PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES
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❑ NEW
RESIDENTIAL
LINE
CHECKEIO YO
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
RETAININGA
REMARKS
SHOULD BE CODED 31.04.
El DEMOLISH N
ALTER ❑ FENCs
❑ ORCPILLTE
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❑ REPAIR ❑ PRE -SWI
NP. ❑ POOL
NUMBER OF STORIES NUM EK OF
DWELLING
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UNITS
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NATURE OF WORK BE DONE 'J ,•-{I. C
Valuation
Fee Receipt No.
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I'lon Check No .....................
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BUILDING
PROPOSED
aPLUMBING
USE
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PLAN (indicate Building setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In-
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formation given Is correct; and that I are the owner, or the duly author-
leed agent of the owner. I agree to comply with City and elate laws regu-
ATTENTION
APPLICATION APPROVAL
Inting construction; and in doing the work authorized thereby, no person
Will be employed In violation at the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
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relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or h18 Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
uty; and fees are paid, and receipt is ac -
Shall be completed In ninety days; MOVED -IN BUILDINGS shall be Sam-
WORK NOTED
knowledged in space provided.
pleted in six months.)
SIGN AT IlE ��iQQQWNE OR AGENT)
DATE SIGNED
INSPECTION'.
DEPARTMENT
DlIYF TOR'8 ,fl�ONAT
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CITY OF
EDRIOND$
DA3'
DATE E
NOTE: Applicant Subject to Plan Geek Fee
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This Permit corers work to be dune on private properly ONLY.
775-2525
Any Construction on the public domain (curb.,sidewalks, drRrow►ys,
marquees, etc.) .rill regWre. separate perndsslon.
FILE
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REPAIR ❑ INSP. ❑ POOL
NUMBER OF STORIES NUMBER OF
)
UNITS
NATURE OFFWWORK TO HE DONE
UPlan
Check No .....................
Vnluatiml
Fee Receipt No.
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BUILDING DEPARTMENT AppucantFM
PERM
E NUMBER
PLUMBING
Insido Heavy Linos
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JOB
HEAT & GAS LINE
FENCE
PERMIT APPLICATION
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SIGN
RETAINING WALL
NAME (OR NAME OF BUBiNEBB)
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TCOVERAOEs
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SWIMMING POOL
LOT
LOT COVEIIAGE
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MAILING ADDRESS
PEHEIOFtT
PltOPOBED HEIGHT
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BLDG. AREA
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I hereby acknowledge that I have read this application; that the in-
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CITY TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL
3y
relating to Workmen's Compensation Insurance.
AUTIIOpU Es
signed by the Building Official or his Dep.
NOTE: Permit limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be nom-
REQUIRED YARDS
PROPOSED YARDS
pleted In nix months.)
SIGNATURE (OWNER Olt AGENT) I DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
INSPECTION
DEPARTMENT
CITY OF
EDNIONDB
775-2525
FRONT SIDE REAR
FRONT ijIDE REAR
INSPECTOR
This I'ernut a work to us done an private property ONLY.
Any construction on thepublic domain (curbs, sidewalk., driveways.
marquees, etc.) will rrQ.In separate permission.
NAME
1.
LEGAL LOT VARIANCE
OR CONDITIONAL USE
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ADDRESS
YES ❑ NO PERMIT NUMBER
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-TELEPHONE
PLANNING DEPT. API•ROVAL
DATE:
NUMBER
CITY
STREET /W
EXISTING STREET R/W ............FT.
DEFICIENCY TIIIe PROPERTY
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NAMII'j _. /
(:Gam. PLAN ST. R/W ............ F'r.
........... .FT.
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REMARKS
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ADDRESS
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BY
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TELEPHONE NUMBER
CIT))IYI
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CHECKED BY
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STATE LICEN E NUASBER I CITY LICENSE NUMBER
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Legal Description of Property lehow Below or Attach Four Coples)
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TYPE CONNECTION
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SERC. TEST \I�
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PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES (:] NO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
SIDENTIAL ❑ LINE
❑PLANS❑BYO
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CITY
❑ NEW
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CHECKED
THIS SITE 15 LOCATED IN THE
SALES TAX
N -RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL
SHOULD BE CODED 31.04.
❑ ADD1:1❑ RETAINING
REMARKS
DEMOLISH WAIT'
❑ ALTER EXCAVATE ElLPEN Cx
❑ ORFILL.......... Ft.)
❑ PRE -MOVE SWIM
REPAIR ❑ INSP. ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
I
UNITS
NATURE OFFWWORK TO HE DONE
UPlan
Check No .....................
Vnluatiml
Fee Receipt No.
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BUILDING
4 PROPOSED USE
PLUMBING
,(
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PLOT PLAN (Indicate Building saltnesss, p.butling streets)
I 1, 1. \) , l `\`
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
APPLICATION APPROVAL
This application is not a permit until
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 .late Tawe regu- ATTENTION
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 THIN PERMIT
relating to Workmen's Compensation Insurance.
AUTIIOpU Es
signed by the Building Official or his Dep.
NOTE: Permit limit One Year (Except DEMOLITIONS which
shall be completed in ninety days; MOVED -IN BUILDINGS shall be nom-
ONLY TI(E
WORK NOTED
uty; and fees are paid, and receipt is ac -
knowledged in space provided.
pleted In nix months.)
SIGNATURE (OWNER Olt AGENT) I DATE SIGNED
NOTE: Applicant Subject to Plan Check Fee
INSPECTION
DEPARTMENT
CITY OF
EDNIONDB
775-2525
D CTOR'B V/AT
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1'
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DATE
INSPECTOR
This I'ernut a work to us done an private property ONLY.
Any construction on thepublic domain (curbs, sidewalk., driveways.
marquees, etc.) will rrQ.In separate permission.