750036.pdfNAME
FRONT SIDE REAR FRONT BIDE REAR
VERIFIED BY
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BUILDING
DEPARTMENT Applicant Ftll
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PERM
NUMBER 750036
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PLANNING DEPT. APPROVAL DATE:
PERMIT
APPLICATION Inside Heavy Lines
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ADDRE.,
TELEPHONE NUMBER
NAME ( N
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of
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PERMISBIPLEACTUAL
LOT COVERAGET.
LOT COVEWAGE
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PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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TGE/LyE/,PHONE NUM/BER
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ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT SIDE REAR FRONT BIDE REAR
VERIFIED BY
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LEGAL LOT VARIANCE OR CONDITIONAL USE
C3 YES NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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REMARKS
COMP. PLAN 8T. R/W ............FT. ............FT.
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ITY LICENSE NUMBER
METER SIZE
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CLEARANCE
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LSgnl Description of Property (snow Below or Attach Four Copies)
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE�$�pDiS' YPE OFN� UCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED OCCUPANCY O
RESIDENTIAL
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❑ YE8 NO
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❑ NEW
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.I
nnn RETAINING
❑ DEMOLISH ❑
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NUMBER ON STORIES NUMBER OF
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UNITE
NATE OF WORK TO HE DONE
Valuation
Fee Receipt No.
Plan Check Na........_...........
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BUILDING
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PROPOSED UeE
PLVMBINO
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PLOT PLAN (Indicate Building Setbacks, abutting streets)
HEAT & GAS LINE
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FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
form¢tlon given le correct; and that I sum the owner, or the duly author.
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I,.t ekent of the owner. I agree to comply with city and state Iawe regu-
le4nIf conetruellon; and in doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the Slate of WashingtonI
relating to Workmen's ComDenentlon Insurance.AUTHORIZES
TIDE PERMIT
This application is not a permit until
Signed by the Building Official or his Dep-
Dep -
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NOTE: Permit limit One Year l DEMOLITIONS which
ONLY THE WORK NOTED
uty; and fees are paid, and receipt is ac -
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shall bcompleted ninety days; MOVED -IN -IN -IN BUILDINGS Shall be cam-
no
kwledd in space
piecedn six months.)
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ge provided.
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AT (OWNER OR AGENT) DATE SfONEU
INSPECTION
DIRECT IONAT
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DEPARTMENT
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CITY OF
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NO Applicant Subject-toEDAIONDS
Plan Check Fee
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covrn worproperty ONLY. work to be done on private
775-2525
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial) '
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(Rough) C: w
Frame ;..
Furnace & Fuel Lines
Final
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