750005.pdfBUILDING DEPARTMENT App11 tFill zOrm NUMBIER
PERMIT APPLICATION Inside Heavy Linos aDs
ADDRESS
NAME (OR NAME OF BUSINESS) 220 Ra i I road Avenue
CITY OF EDMONDS LOT COVBen ae ACTUAL
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IC MAILING ADDRESS
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❑
250 -5th Ave. North
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
P.
INF.
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® NON-RESIDENTIAL
❑
CITY
ADD
_
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
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NOTE: Permit Limit One Year (E.eept
I VERIFIED BY
AVATE
ILL
❑
Edmonds, Wa.
775-2525
REPAIR
❑ PN Pa10VE
O
POOL
UMBER OF STORIES NUMBER OF
FIRE ZONE TYPE O
CONSTRUCTIONSTREET IMPROVED
NAME
DWELLING
I
REQUIRED YARDS
FRONT SIDE REAR
PROPOSED YARDS
FRONT HIDE REAR
^
UNITS
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P cxsc E HY THIS SITE IS LOCATED IN THE CITY
Harry C. Nelson d Assocls.
OF EDMONDS. LOCAL SALES TAX
CITY OF-
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MA
SHOW D BE CODED 31.04.
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ADDRESS
DATE
LEGAL LOT VARIANCE OR CONDITIONAL USE
YES [] NO PERMIT NUMBER
Thi. 1'ertall r..en work to be done on private property ONLY.
775.2525
DD
6504 -225th Place S.W.
PLANNING DEPT. APPROVAL
DATE:
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CITY
TELEPHONE NUMBER
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Mt I k. Terr, Wn.
774-6151
STREET R/W
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NAME
EXISTING STREET R/W ............FT.
DEFICIENCY TItle PROPERTY
South bounty Senior Center
COMP. PLAN ST. R/W ............FT.
REMARKS
............ IT
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ADDRESS
220 Railroad Ave.
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F
_U1TY
TELEPHONE NUMDER
CHECKED BY
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Edmonds, We.
_
METER SILb et.RV10E SIZE CLEARANCE
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[ hereby acknowledge Nat I have reed this application; Ihnt the In.
RESIDENTIAL
❑
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NEW
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INF.
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® NON-RESIDENTIAL
❑
SIGN
ADD
E] DEMOLISH
F i
RETAINI
WALL LLE NGFt.)
ALTER
EXCOR
TYPE CONNECTION
NOTE: Permit Limit One Year (E.eept
I VERIFIED BY
AVATE
ILL
❑
PLR[. TEST
DEMOLITIONS w'hlch
shall he completed In ninety days; MOVED -IN BUILDINGS shall be eons-
REPAIR
❑ PN Pa10VE
O
POOL
UMBER OF STORIES NUMBER OF
FIRE ZONE TYPE O
CONSTRUCTIONSTREET IMPROVED
I NO
DWELLING
I
SPECIAL INSPE TOR
-
UIRED OCCUPANCY GROUP
1 O SIONATU
UNITS
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)
[ hereby acknowledge Nat I have reed this application; Ihnt the In.
BUILDING
I Fees Waived
PLUMBING
ORLCKED HY
HEAT & GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
REMARKS
DEMOLITION
F i
PRE -MOVE INSPECTION
TIDS PERMIT
j'
TYPE CONNECTION
NOTE: Permit Limit One Year (E.eept
I VERIFIED BY
Signed by the Building Official or his Dep.
PLR[. TEST
DEMOLITIONS w'hlch
shall he completed In ninety days; MOVED -IN BUILDINGS shall be eons-
PERMIT NUMBER
d,
I
ItEMARX8
plated In Sly. month..)
FIRE ZONE TYPE O
CONSTRUCTIONSTREET IMPROVED
I NO
1
SPECIAL INSPE TOR
-
UIRED OCCUPANCY GROUP
1 O SIONATU
0 YES O
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P cxsc E HY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
CITY OF-
I yt
MA
SHOW D BE CODED 31.04.
NOTE: Applicant Subject to Plan Check Fee
EDhIONDS
DATE
Thi. 1'ertall r..en work to be done on private property ONLY.
775.2525
DD
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Fee Recelpt No,
flan Cheek No .....................
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[ hereby acknowledge Nat I have reed this application; Ihnt the In.
BUILDING
I Fees Waived
PLUMBING
'
HEAT & GAS LINE
FENCE
SIGN
N
RETAINING WALL
SWIMMING POOL
ATTENTION
DEMOLITION
PRE -MOVE INSPECTION
TIDS PERMIT
EXCAVATION OR FILL
[ hereby acknowledge Nat I have reed this application; Ihnt the In.
TOTAL AMOUNT DUE
I Fees Waived
rN one I
'
farmntlon given Is correct; and that I stn the owner, or the duly author-
Izetl ascot of the owner. 1 agree to tomplY with ally and State law. reed•
construction;
!.ting construction; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed Violation of the Labor Cade of the Sidle of Washington
relaling to Workmen's Compensation Insurance.
TIDS PERMIT
This application is not a permit until
NOTE: Permit Limit One Year (E.eept
AUTIIONZES
oxer TILE
Signed by the Building Official or his Dep.
j
DEMOLITIONS w'hlch
shall he completed In ninety days; MOVED -IN BUILDINGS shall be eons-
µ'0R1[ NOTED
uty; and fees are paid, and receipt is ac -
plated In Sly. month..)
11nOWled ged in Space provided.
'3GNATUIiE (OWNER O} GENT) DATE SIGNED
INSPECTION
1 O SIONATU
DEPARTMENT
CITY OF-
'
NOTE: Applicant Subject to Plan Check Fee
EDhIONDS
DATE
Thi. 1'ertall r..en work to be done on private property ONLY.
775.2525
DD
Any eomdructlon an the public damaIn (curb.. eldewalk., driveways,
mnredrr., M,J ,Ill rranlrr, .rpdrnlr rrrinl..lon.
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