750067.pdfBUILDING DEPARTMENT
USE
ZONE PERMIT ER 7,.5 -0067
Applicant Fill
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PERMIT APPLICATION Inaldo ]icnVy Linos
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NAME (OR NAME OF BUSINESS)
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PEItM1t1Be1DLE ACT AL
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L.T COVERA% GE
( )L LOT COVE�AGE D
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MAILING/-
ADDRESS
PERM3tltlIBLE HEIGIl,T� PROPOSEDIIEIOHT`
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3 7-7Z y tyoclwillew o2
O CITY
TELEPHONE NeUMBER
ACTUAL LOT AAE TOTAL O. ARE
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'7W 94'_2—
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, RFQ IRED YARDS PROPOSED YARDS
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NAME
FRONT HIDE REAR FRONT BIDE REAR
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Ill ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL U8
IN YES ❑ NO PERMIT NUMBER
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PLANNING P V L ATJty
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TELEPHONE NUMBER
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STREET R/W
EXISTING STREET R/Gal`.' .`/.�f'I'. DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN ST. R/1411��01.1. .....Q..FT.
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REMARKS Driveway slopes not to exceed those
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indicated an StandardDwg. No.
103
CHEC D SY
4' CITY
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TELEPHONE NUB113ER
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STATE LICENSE NU MBERCITY
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LICENSE NUMBER
METER SIZE SL•-ItVICE SIZECLEARANCE
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Legal Description of Properly (Shaw Below
or Attach Four Copies)
REMAl tl
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TYPE CONNECTION
VERIFIED BY
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PLRC. TEST
PERMIT NUMBER
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REMARKS
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FIRE'?(`ENE TYPE OF CONSTRUCTION SSTRREEET 3E(PROVED
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i�'� L'f :cB ❑ NG-
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SPECIAL INSPECTOR REQUIRED OCCUPANCY r• UP
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RESIDENTIAL
❑
❑ YEBLAN [10
NEW
LINE
PCHECKED BY THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL
Bich
I OF EDMONDS. LOCAL SALES TAX
HOULD BE CODED 31.04.
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ADDREMAINING
DEMOLISH WL
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ALTER EXCAVATE❑ FENCE
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E]OR FILL (..........x..........Ft.)
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REPAIR PRE -MOVE SWIM
INSP. POOL
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NUMBER OIC BTORIF.S NUMBER OF
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Q/:,/L i� I�AStriLlt DWELLING /
UNITS
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NATURE OF WORK TO RE DONE
P�vsi
Valuation
Fee Receipt No.
Plan Check No.- .................
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BUILDING
7GA77- 3
PAOP09ED U8E
PLUMBING
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PLUT PLAN (Iudlc¢to Building actbacka, abutting street.)
HEAT A GAS LINE
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d
FENCE
SIGN
tRETAINING
WALL
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8WIM1IMING POOL
DEMOLITION
PRE -MOVE INSPECTION
,
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that 3 have rand this application; that the m•
formationgiven Is correct; untl that I am the owner, or the duly author.
or
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lud agent of the owner. 1 agree to comply with city and slate laws regu•
mNng construction; and In doing the work authorind thereby, no person
ATTENTION
APPLICATION APPROVAL
Will be employed In vloinllen of Ne Labor Code or the State of Weehinglon
re to
THIS PERMIT
This application is not a permit until
workmcn•a Compensation Insurance.
T
OTE: Permit Limit One Year
AuruolTHEe
ONLY
signed by the Building Official or his Dep -
(Except DEMOLITIONS which
150RR NOTED
OTE
uty; and tees are paid, and receipt is ac-
Shall be completed In ninety days; MOVED -IN BUILDINGS shall be wm-
knowledged in space
pleted In six months.)
provided.
SIGNATURE (OWNER It AO NT) DATE SIGNED
INSPECTION
DIO'B 8I NATU
DEPARTMENT
/
L-:1rZ! //t+%NL �'• i
CITY OF
EDMONDS
ATE
NOTE: Applicant SB Hct to Plan) Check Fee
— �01
Pe It veven ire rk to bo done on prlyale property ONLY.
775-2525
All,
AnY tonsirnrtlnn MI the public Ummmln Irurh., .Idewniks, drh'en'ayn,
el,1 i,lu r.viarr ..para(. ndssmn.
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