750109.pdf-
RMIT
BUILDING DEPARTMENT I AppllCOIItFill °� "° 75010,
PERMIT APPLICATION Inside Heavy Lines LS
NAME (OR NAME OF BUSINESS)
S u N s Er c L,7o�J fNUMBER
MAILING ADDRESS
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W INAME
ADDRESS
7
STREET R/LV
EXISTING STREET R/ ..
RESIDENTIAL
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CITY
TELEPHONE NUMBER
NEW
❑
NON-RESIDENTIAL
NAME
SIGN
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WALL RETAIKING
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ALTER
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CIT TELEPHONE NUMBER
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ENC
FRONT 'I'D",REAR
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STATE LICENSE NUMDElt
CITY LICENSE NUMBER
LEGAL LOT
1,t3-ol-/LF9�87
YES C] NO
REPAIR
Legal DuscNptien a[ Yraperly (Show Below
or Attach Four Copies)
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NUMHEA OF
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A
JOB
STREET R/LV
EXISTING STREET R/ ..
RESIDENTIAL
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Fee Receipt No.
COMP. PLAN ST. R....LL/ WFT.
NEW
❑
NON-RESIDENTIAL
❑
SIGN
ADD
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DEMOLISH
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WALL RETAIKING
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ALTER
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ENC
FRONT 'I'D",REAR
BER
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REPAIR
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PNSPTIOVE
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SWIT
NUMBER OF STORl E8
NUMHEA OF
A
DWELLING
Z
UNITS
JOB
STREET R/LV
EXISTING STREET R/ ..
DEFICIENCY THIS PROPERTY
ADDRESS
Fee Receipt No.
COMP. PLAN ST. R....LL/ WFT.
PERMISSIBLE ^
IAT COVERAGES/
REMARKBDriveway slopes
OA A,11
ACT '
LOT
indicated on Standard Dwg.
No 1�0�3Q)j
PERMISSIBLE
MISSIBLLEEAA3H•jEIGHT�1
PROPOSED HEIH
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TOTAL BLPROPOSED
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FRONT SIDE REAR
FRONT 'I'D",REAR
BER
REMARKS
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VARIANCE Olt CONDITIONAL USE
YES C] NO
PERMIT NUMBER<,fs.n L .4N f9 N0 Per
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PLANNING DE T. P OVA T
STREET R/LV
EXISTING STREET R/ ..
DEFICIENCY THIS PROPERTY
�..rFr.
Fee Receipt No.
COMP. PLAN ST. R....LL/ WFT.
...�..�..FT.
REMARKBDriveway slopes
not to exceed those
indicated on Standard Dwg.
No 1�0�3Q)j
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1I \Y
ME 21ZL•' I SERV,iC��ZE I CLEARANCE
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TYPE CONNECTION NTf
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PERC.
BER
REMARKS
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FIRE- ZDjr {E TYPE OFC NBTRUCT ON BTREE V. IMPROVED
-"fes -� �(„/ YE I [:] NO
EPECIAL INSPECTOR UIRED I OCC NCY GROUP
S
YES
PLAN CHEC ED BY THIS SITE IS LOCATED IN THE CITY
7.1 /1 / OF EDMONDS. LOCAL SALES TAX
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
I-Inn Check No .....................
j
�j ` / l.tC
W
BUILDING
/,r
PROPOSED USE
PLUMBING
/J
aPLOT PLAN (Indicate Building Setbacks, abutting streets)
HEAT & GAB LINE
A
FENCE
SIGN
RETAINING WALL
N
1
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that Ne In-
formation given Is correct; and that I am the owner, or the duly cu thor.
Ized agent of the owner. I agree to comply with city and state laws mgu-
ATTENTION
APPROVAL
lating construction; and In doing the work authorized thereby, no person
.APPLICATION
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 Imurance.
AUTHORIZES
Signed by the Building Official or his Dep -NOTE:
f
Permit Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
R'ORH NOTED
ut and fees are aid, and receipt is ac-
y� P l)
`—
shall be completed In ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged In space provided.
Dleted In six months.)
SIO ATORE (OWNER OR AGENT) DATE SIGNED
INSPECTION
}RE O 'e IG ATURH
/ I
L
DEPARTMENT
J
CITY OF
% Fee
EDMOND3
DATE
'
NOTE: Applicant Subject to Plan Cheek
775-2525
r 7
Title Permit coven work to be done on private property ONLY.
,Any eon ri nirlbm an Ihr public dmmalo (curbs, 01—aike, &I—rays.
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RECORD OF INSPECTIONS y
Date Passed J