750061.pdfPlan Check No .....................
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PERMIT APPLICATION
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PLOT PLAN (Indicate Building aclb¢Cke, ab`tting ,trials)
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I hereby acknowledge that t have rend this application; that the In.
EXISTING STREET R/W ............Fr. DEFICIENCY THIS PROPERTY
formation given Is correct; and that I am the owner, or the duly author-
NAME
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COMP. PLAN ST. RJW ............FT. ....,.......FT.
[zed agent of the owner. I agree to comply with city and state Inmos reg`-
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APPLICATION APPROVAL
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Toting construction; and In doing the work authorized Ihereby, no person
REMARKS
will be employed In violation or the Labor Code of the Slate of Washington
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ADDRESS
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Signed by the Building Official Or his Dep-
CHECKED BY
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,hall be completed In ninety days; atOVED•IN BUILDINGS shall be cam.
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TELEPHONE NUMBER _
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pleted In six menthe.)
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METER BILE SERVICE SIZE CLEARANCE
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CHECKED BY
IRE TO 'S RIGNATUAE
SCE8E NUMBER
TAT L1N
CITY LIGENIIE NUMBER
DEPARTMENT
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CITY OF
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EDMONDS
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REMARKS
NOTE: Applicant Subject to Plan Check Fee—
775-2525
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This Permit covers work to be done on private properly ONLY.
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Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IdiPROVED
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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PLAN CHECK D n THIS SITE IS LOCATED IN THE CITY
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❑ NON-nESIDENTIAL
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OF EDMONDS. LOCAL SALES TAX
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❑ vALL
R)MARE
DEMOLISH
EXCAVAOR
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ALTER ❑
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❑ REPAIR ❑ NSIPSrfOVE
El SWIM
POOL
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NUMBER Ob` STORIES NUMBER OF
DWELLING
UNITS
Plan Check No .....................
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4 N lT'L 0 V /%: Q U C4 C a,r& 0 !
BUILDING
PROPOS
PLUMBING
U
PLOT PLAN (Indicate Building aclb¢Cke, ab`tting ,trials)
HEAT A GAA LINE
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FENCE
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SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
_ (% 97S 7
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I hereby acknowledge that t have rend this application; that the In.
formation given Is correct; and that I am the owner, or the duly author-
i
[zed agent of the owner. I agree to comply with city and state Inmos reg`-
ATTENTION
APPLICATION APPROVAL
Toting construction; and In doing the work authorized Ihereby, no person
will be employed In violation or the Labor Code of the Slate of Washington
TITIN PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance,
AUTHORIZE,
Signed by the Building Official Or his Dep-
'
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TII
WORK NOTEE D
uty; and fees are paid, and receipt is ac-
,hall be completed In ninety days; atOVED•IN BUILDINGS shall be cam.
knowledged in space provided.
pleted In six menthe.)
SIGNATURE (OWNER Ott AGENT) DATE SIGNED
INSPECTION
IRE TO 'S RIGNATUAE
_
DEPARTMENT
CITY OF
�,
EDMONDS
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NOTE: Applicant Subject to Plan Check Fee—
775-2525
—
This Permit covers work to be done on private properly ONLY.
Any construction on the public domain (curb., eIdewalks, drivew"..
m.vqurrx, rir.1 will n'eulrr .rymmlr prrnd,elnn.
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