750035.pdfBUILDING DEPARTMENT Appa(aatFill
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NUMBER 750035
inside Heavy Lines
PERMIT APPLICATION I
ADDRESS
NAME (OR NAME OF HU...E'BBI)
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LOT COVERAGE?/
LOT COVERAGE
LOT CO
LOT COVEf�AOE
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MA3 NO AD 88
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PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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ACTUAL LOT AREA
TOTAL BLDG. AREA
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CITY
P ONENUMBBER
TELEPHONE NUMBER
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REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT BIDE
REAR FRONT SIDE REAR
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en
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LEGA LOT VARIANCE
Oil CONDITIONAL USE
FV
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B 0 NO PERMl NUMBER
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L G DEPT O A
CITY
TELEPHONE NUMBER
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EXISTI STREET R/W ............FT.
FIC}ENCY THIS PROPERTY
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NAME
CO PLAN ST. R/W
FT.
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REMARKS
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ADDRESS
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CHECKED BY
CITY//S
TELEPHONE NUMBER
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METER SIZE SERVICE SIZE CLEARANCE
CHECKED HY
b�rAT ICENBE NUMBER
CITY I.ICENBE NUMBER
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REMARKS
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Legal Description or Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
VERIFIED BY
Lots 13, 14, 15 and E. IOW of lot IZ
PERC. TEST
PETMITN IBER
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Block 79 – CItV of Edmonds
REMARKS
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F3RE�ptE TYPE OF�NBTRUCT]ON
STREET IMPROVED
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�( /J.l/��—Yv , /rte) YES NO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
6A.
❑ YES NO
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RESIDENTIAL
NEW LINE
PLAN CUE CKE DY
THIS SITE IS LOCATED IN THE CITY
LOCAL TAX
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NON-RESIDENTIAL ❑ SIGN
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OF EDMONDS. SALES
ADD ❑ RETAINING
DEMOLISH WAIL
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ALTER EXCAVATE ❑ FENCE
OR FILL (.........X..........Ft.)
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REPAIR PRE -MOVE swim
INSP. POOL-
NUMHER OF BTORIE9 NUMBER OF
DWELLING
I
UNITS
NATURE OF WORK TO BE DONE
Vnluntion
Foe Recelpt No.
all,
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Plan Check No ..... ...............
BUILDING
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PROPOSED USE
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PLUMHIN6
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a
PLOT PLAN (Indicate Building eetbacke, abutting elrocte)
HEAT A GAS LINE
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0
FENCE
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SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMODNT DIB:
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I hereby acknowledge that I have read this application; that the In.
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formation given Is correct: and that I am the owner, or the duly author-
Iztd agent of the owner. I agree to comply wItb city and slate )awn rogu.
ATTENTION
APPLICATION APPROVAL
lating construction; and 1..3.1.1 the work authorized thereby, no person
will be einfft, d In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
rotating to workmen'. Compensation insurance.
AUTHORIZES
Signed by the Building Official or his Dep-
1
NOTE: Permit Limit Ono Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
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shall be completed In nl.ety days: MOVED -IN DUnMtNGS shall be wm-
knowledged in.epace provided.
Dieted In six month..)
B10NA RE (OWNER OR AGENT)
DATE S10NED
INSPECTION
D C 'S B ATURE�
DEPARTMENT
CITY OF
r
EDDiOND96-1107'DATE
NOTE: Applicant Subject to Plan Check Fee
PR g-1I
1-7
This Pcrmtt coven work to be done on private property ONLY.
Any ro.etre,tfon o. the public 11* (earbe, sldewMke, dr—T.,
FILE
etc.) will '_1'e .epar.te pvnJe.lon.
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750035
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RECORD OF INSPECTIONS 1 .
Date Passed
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final f `''i "ID'
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