750075.pdfPNUMBER ERMIT 750075
ACTUAL
LOT COVE AGE �—
Y /J_C
BUILDING DEPARTMENT(
Applicant Fill
°NE C6-
PERMIT APPLICATION
Insldo Ifeavy Lines
JC R
NAI/EI'R NAME OF RU b"2198)
TJ/ .(/ ri, i, �
ADDRESS
7.
IAT COVERAGE
PNUMBER ERMIT 750075
ACTUAL
LOT COVE AGE �—
Y /J_C
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REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REAR
a'
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RESIDENTIAL
❑ LINE
ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
F
7
❑ NON-RESIDENTIAL
❑ SIGN
[] YES (:I NO PERMIT NUMBER
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REMARKS
DEMOLISH
ALTER
PLANNING DEPT. APPROVAL DATE:
09 CITY
TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
REPAIR O
NSP ❑ POOL
A
a
COMP. PLAN ST. R/W ............FT. ............FT.REMARKS
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I CHECKED BY
FELEPHONE
ONNUMDER
•76
-
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METER SILL
SERVICE SIZE CLEARANCE
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CHECKED BY
C r�j•/''8E •/Nl'jD}JER
t
C/.I,TY Ll ftN E N MBEiIII
of Dee Cl{dlon a( PropC[LY lShow Be:— aK�¢e�ch Four Copies;
REMARKS
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BUILDING
-
/i •
PROPOSED USE
J.
TYPE CONNECTION
VERIFIED BY
O
PLUMBING
I
lO.
L,
Y
a
PL•RC. TEST
I PERMIT NUMBER
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REMARKS
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FIRE 2QyS 1 TYPE OF CONSTRUCTION I amac�cm rn.nnnvsn
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,Jy / / 6 r` lsf /^---V I YES "Vo
SPECIAL INSPECTOR REQUIRED PANCY GROUP 7'
OCCU
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RESIDENTIAL
❑ LINE
❑ YES No
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PLAN CHECKED HY
❑ NON-RESIDENTIAL
❑ SIGN
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 3104
ADD RETAINING
WALLID
REMARKS
DEMOLISH
ALTER
❑
ORFILL❑ `ENC z..........Ft.)El
PRE-MSWIM
REPAIR O
NSP ❑ POOL
NUAfIIEIi Ol• eTOlt[LS NUM EaOF
DWELLING
UNITE
/ 7 7
- ,((�� i • / / sKJG
NATURE OF WO TO HE DO�
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Valuation
Fee Receipt No.
-
Plan Check No .....................
Z
0
BUILDING
-
PROPOSED USE
O
PLUMBING
PLOT PLAN (Indicate Bullding Setbacks, nbullln6 street.)
HEAT & GAS LINE
Q
0
I
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend lhle application; that the In-
formation given Is correct: and that I nm the owner, or the duly nulher-
Iretl agent of the owner, t agree to comply with city and erste lows ...on
latfng construction; and In doing the work authorized lheraby, no psreon
ATTENTION
APPLICATION APPROVAL
will be employed In violation or the Labor Code of the Slate of Washington
relating to Workmen's Compensation Insurance.
THIS PERMIT
This application is not a permit until
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Eecepl DEMOLITIONS which
ONLY T
µ-GSR NOTED
cetyl and fees are paid, and receipt 1s ae-
be complete. In ninety days; MOVED -IN BUILDINGS shelf he mm-
knowledged in
pictesholl
pieta_, 1 el: cnthe,)
space provided.
Olt AGENT) DATE SIGNED
n
INSPECTION
DEPARTMENT
DIREC Tq 'S SIO U A
/{
0
CITY OF
EDMONDS
DATE3
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NOTE: Applica��il ItGjrcf to Pial Check Fee
This Permu n k m done on Private properly Ueway
775.2525
Any esnslrnellml sn lig. 0 NI _,¢main (cU rbn, nldrn'nikn, drh'ew'nyn,
rvt r..,III rrvmilrr srpn lig• Inl�nli.n.I
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