750099.pdfAD
ADDRESS
PERMIT
APPLICATION
ACTUAL
LOT COVEWAGE
PERMISSIBLE HEIGHT
Inside Heavy Lines
ACTUAL LOT AREA
NA7� � (OR NAME OF
UBlN 8 )
PROPOSED YARDS
REARFRONTSIDE REAR
jer,
PLUMBING
LEGA VARIANCE OOIi CONDITIONAL USE
E) YES ❑ NO PERMIT NUMBER
NAME
DEMOLISH
EXCAVATE
M A3 NO ADORES
�
RETAINING
FE
REMARKS
❑
C3
W
...... .......Ft.)
TELEPHONE NUMBER
REPAIR
NAME
NB PRE -MOVE
❑
SWIM
POOL
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'UM➢ER OF BTOftiES
NUMBER Oil
C ADDRESS alO
IUd A13DREBB
AD
ADDRESS
F
V
PERMISSIBLE
LOT COVERAGE
ACTUAL
LOT COVEWAGE
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
FRONT SIDE
PROPOSED YARDS
REARFRONTSIDE REAR
jer,
PLUMBING
LEGA VARIANCE OOIi CONDITIONAL USE
E) YES ❑ NO PERMIT NUMBER
NEW
F
V
PLANNING DEPT. APPROVAL DATE:
GASLINE
❑YES] NO
F.
CITY
TELEPHONE NUMBER
STREET R/W
EXISTING STREET R/W ............FT, DEFICIENCY THIS PROPERTY
NON_RESIDENTIAL
I
SIGN
PLUMBING
I / T ADD
ALTER
NAME
DEMOLISH
EXCAVATE
O
❑
RETAINING
FE
REMARKS
❑
COMP. PLAN BT. R/W ............FT. ............FT.
W
...... .......Ft.)
REMARKS+
REPAIR
9F-:� _
NB PRE -MOVE
❑
SWIM
POOL
I
'UM➢ER OF BTOftiES
NUMBER Oil
C ADDRESS alO
CHECKED BY
UF7
DWELLING
CI
F
TELEPHONE NUM➢ER
V
UNITS
RETAINING WALL
METER SIZE
I SERVICE SIZE
I CLEARANCE
I CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Deecrlptlon at Pracerty (show eetow or Attach Four Copley)
REMARKS
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NEW
Is RESIDENTIAL
❑
GASLINE
❑YES] NO
F.
PLAN CHECK.
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Ln
NON_RESIDENTIAL
❑
SIGN
PLUMBING
I / T ADD
ALTER
❑
DEMOLISH
EXCAVATE
O
❑
RETAINING
FE
REMARKS
❑
ROFILLTE
OR
...... .......Ft.)
REPAIR
❑
NB PRE -MOVE
❑
SWIM
POOL
I
'UM➢ER OF BTOftiES
NUMBER Oil
DWELLING
UNITS
RETAINING WALL
/-//,4
INSTRUCTION STREET IMPROV)
—0 C] YES )d NO
Fee Receipt No.
Plan cheek Nn .....................
BUILDING
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PROPOSED � USE
F%
PLUMBING
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„�(�iL3ei:ZCL/Fu"LL� /.�3'��6-tGuLCK.'•CLd-?C_l
PLOT PLAN (Indlcata Duli setbacks, abutting sir ete)
HEAT k GAS LINE
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FENCE
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SIGN
T z,
RETAINING WALL
SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In.
forma tlon given Is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply With city and state laws regu-
ATTENTION
APPLICATION APPROVAL
IntlnR conetructloa; and In doing the wort[ 6utharized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTUORIZEB
signed by the Building Official or his Dep-
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NOTE: Permit Limit One Year (Except DEMOLITIONS wbleh
ONLY THE
YORK NOTED
UIy� and fees are paid, and receipt is ac -
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
SIGN ItE (O\VNEA, O AGENT)
DATE SIGNED
INSPECTION
IRECTOR
-RECTO' 8I0 U
DEPARTMENT
CITY OF
-/
NOTES Applicant Subject to Plan Cbrck Fee
EDMONDS
DATE
T 7 S�
This 1'emilt euven work to be done an private property ONLY.
775-2525
Any eonetruetiun on lbs public dcmnln (curhe, nldewwlks, drlvewaye,
nr.,rn�irr•v, rlr.� ulll rrgnlm nrpanii1"km. _
-
FILE
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RECORD OF INSPECTIONS
Date, Passed
Foundati"..
on
Plumbing (Partial)
(Rough)
Frame'
Furnace & Fuel Lines
Final .
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