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BUILDING DEPARTMENT Applicant Fin ° _ NUMBER 7501 I J lyj'
PERMIT APPLICATION Inside Heavy Linos d08
ADDRESS
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LOT COVERAGE
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�7 LOT VERAOE
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PLItMIdBIBLE HEIOIIT
PIfOY,BED HEIGHT C
--CITY
TELEP ONE NUMBER
ACTUAL ;OA Z7K 1
TOTAL H , EAI
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REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT BIDE
REAR FRONT SIDE REAR
ADDRESS
OTVKRIANUN Olt NDI IONAL UBE
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61YES NO PERMIT NUMBER
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PLANNING D P APPR
AL 4 7
CITY
TELEPHONE NUMBER
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SWIM L -T RV
EXISTING STREET R/W ............FT,
DEFICIENCY THIS PROPERTY
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NAM
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II11 11JJ C I(
COMP. PLAN ST. R/W ............FT.
...........FT.
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REMARKS
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ADT
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CHECXED BY
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CITY
TELEPHONE NUMBER
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UMETLR
SILL
SERVICE SIZE
CLEARANCE
CRECHE Y
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UTAE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
Legal DaeCrlptlon of Yroparty (ShoW Below r Attach Four Copies,
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TYPE CONNECTION
ECTION
VERIFIED B
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Si too -01- w (35 Ft
PL•RO. TEST
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION
STREET IMPROVED
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M/YES (:] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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CAS
RESIDENTIAL
❑ LINE
❑YES
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xety
PLAN CHECi Y
THIS SITE 15 LOCATED IN THE CITY
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NON-RESIDENTIAL
❑ SIGN
ry
OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
--77CC ❑ DEMOLISH NrALL
MARKS
H..LD BE CODED 31.04.
ALTER EXCAVATE FENCE
/Ii/ C%/,LS/�
1`>
OR FILL .
❑ ❑
L/�' i /Gy / 6/6 r� L�,3
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..........
REPAIR PRE -MOVE SWIM
INSP. POOL
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N .�I/ C //i/.) l'�� %%Q/✓ j
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NUMBER.OF STORIF-S 11 NUMBER OF
DWELLING
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y�. UNITS
NATURE OF WORK TO
E Dp E
Valuation
Fee Receipt No.
Jt71�7-(
Plan Cheek Na .....................
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tw Il
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1 t(� IWnI•%
Hoped..
BUILDING
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BE
PLUMBING
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PLOT PLAN (Indicate Bulldln6 eetbneke, nbultln6 streets)
HEAT A GAS LINE
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FENCE
1 I
SIGN
RETAINING WALL
BWISIMIN6 POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the !n-
formal given Is correct; and that I stn the owner, or the duly nuthor-
Ired agent of the owner. I agree to comply with city and dela laws reg'-
Inting construction; and In doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
Will be employed 11 vlolntlaa of the Labor Coda of the Stale of Washington
to Workmen•a Compensation Insurance.
THIS PERMIT
This application is not a
pp permit until
relatlpg
NOTE: Permit Li it One Year (Except DEMOLITIONS
AUTHORIZES
ONLY TZE
Signed by the Building Official or his Dep-
which
WORK NOTED
utyi and fees are paid, and receipt is ac-
"
ehal ba completed In sly days; !101.10 -IN 6UILDIN08 shall be cum•
knowled ed in s
g pace
pie e i mx on eI)
provided.
Sl T RE ONCr AGE T)
DAT SIO ED
INSPECTION
IHR. T B B BIGNATU
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DEPARTMENT
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CITY OF
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NOTE: Applicant Subject to Plan Check ee
EDMOND$
AT
775-2525
This I•ern't euvrrs walk to be done on prlvate properly ONLY.
Any const ruction on the public domain (eurbn. nldeWalko. driveway.,
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