750089.pdfI
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BUILDING DEPARTMENT
ZONE
NUMBETR 75008`
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InsidepHeavy Lines
PERMIT APPLICATION
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ADDRESS-
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NAAtE OR NAME OF IIUe1NEBe
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PER MCI SIBLE a
ACTUAL
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LOT COVERAGE
LOT COVEAOE
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PL•-IIAtItltlIHLE HEIGHT
PROPOSED HEIGHT
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TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
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REQUIRED YARDS
PROPOSED YARDS
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NAME'
FRONT SIDE
REAR FRONT SIDE REAR
LEGA I. LOT VARIANCE OR CONDITIONAL USE
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ADDRESS
YEB 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER
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STREET R/W
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NAME
x
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COMP. PLAN ST. R/W ............FT.
............FT.
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REMARKS
14,
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ADD 58d �
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CHECKED BY
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CITY
TELEPHONE NUMBER
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77k 3/
METER BILE SERVICE
-SIZE CLEARANCE
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CHECKED BY
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STATE LICENSE NUMBER
-CITY L CEN�BE NUMZB-);H�1
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Legal Description of Property (Show Below or Attach Four Copies)
REMARKS
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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 IMPROVED
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YES [3 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
RESIDENTIAL
NO
❑PLANSCHECKED❑BY
I
E] NEW
INE
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
RETAINING
REMARKS
SHOULD BE CODED 31.04.
DEMOLISH WAIT'
❑
FENC
ALTER EXCAVATE ❑
OR FILL
❑ FILL (...........Ft.)
REPAIR ❑ PRE-INSPA[OVE El swif
POOL
NUMBER OF STORIES NUMBER OF
I
DWELLING
I
UNITS
NATURE OF WORTS TO H DONE
Valuation
Fee
Receipt
No.
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lAaln, LIZ Z
6 . .
Plan Check No. ....................
3
BUILDING
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PROPOSED USE
�n
PLUMBING
a
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
1
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FENCE
SIGN
tRETAINING
WALL
SWIMMING POOL
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DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have rend this application; that the in.
formatlon given Is correct; and that I am the owner, or the duly author-
I2ed agentof tno owner. I ¢gree to comply with city and elate laws rogu•
ATTENTION
APPLICATION APPROVAL
lnling construction; end In doing the work aulhorlsed thereby, no person
will be employed In violation of the Labor Code of the stale of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
'
NOTE. Per 111i Limit One Year (Except DEMOLITIONS which
ONLY THE
µ0 NOTED
uty; and fees are paid, and receipt is ac-
I'll be mpleled�n ninety days; AfOVED-IN BUILDINGS shall be cont-
lrnowledged In space provided.
fisted 1 0 moat a,)
IONE to Ell OR AGENT)
DATE IGNE
INePECTION
DEPARTMENT
DI TOR'B IONAT
/
n
CITY OF
c�icc
DATE
NOTE: Applicant Subject to Plan Check Fer
—
775-2525
This 1'ennit covers, to be dulls on Private property ONLY.
Any construct,.. oa the public d.maln Icurb., sidewalks, driveways,
marquees, etc.) will require separate permiselan.
FILE
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