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BUILDING DEPARTMENT
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PERMIT APPLICATION
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ADDRESS C( 2— I -r-
NAME (pR BUBfN$BB)
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PERMI ItM1 VERA ACT
LOT I..... UAL OL A COV EE�AGE
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PERMISSIBLE HEIGHT ROPOSED RZIOHT
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EPRONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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776-s''IG
REQUIRED YARDS PROPOSED YARDS
NAME
FRONT BIDE REAR FROBIDE REAR
71_
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ADDRESS
LEGAL LOT VARIANCE OR CONDITIONAL USE
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Q YES 0 NO PERMIT NUMBER
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PLANNING EPT. APPROVAL I'
CITY
TELEPHONE NUMBER
STREET R/W a Ii7
EXISTING STREET R/W ............ FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ...........FT. ............FT.
REMARKS
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ADDRESS
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9 CITY TELEPHONE NUMBER
BY
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ICHECKED
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METER SIZE SERVICE SIZE
CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Four Coplee)
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TEST PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OFC BTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
GAS
❑ YES '0470
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NEW RESIDENTIAL LINE
PLAN cHEo. ' THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL slcx
OF EDMONDS. LOCAL SALES TAX
ADD RETAINING
HO LD BE CODED 31.04.
REMARKS
F] DEMOLISH O
ALTER EXCAVATE FENCE
❑ OR FILL (..........z..........Ft.)
REPAIR
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❑ INSP. ❑ POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Recelpt No,
Plan Check No.....................
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BUILDING
Y PROPOSED USE
PLUMBING
1�fJ
ZPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
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FENCE
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SIGN
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RETAINING WALL
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BWIsiMINO POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this appllCntion; that the In-
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formation given Is correct; and that I am the owner, or the duly author.
Ized agent o[ the owner. I agree to comply With city and state laws rasa•
ATTENTION
APPLICATION APPROVAL
leting construction; and la doing the work authorized 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 workm
men's copenenuInsuraInsurance.oa Insurance.
AUTHORIZES
Signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
ehall be completed In ninety days; MOVED-IN BUILDINGS shall be nom.
knowledged in apace provided.
plated In six months.)
e ATURE (OWNS OR AGENT) DATE 81GNEU
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INSPECTION
DEPARTMENT
DIRECTOR. SIGN U E
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CITY OF
NOTE: Applicant Subject to Platt Check Fee
EDBfOND3
DATE
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775.2525
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This Permit Corers work to be done on private property ONLY.
Any construction on the public domain (curbs• sidewalks, driveways,
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marquees, ate.) will regWre separate Derminlon.
PERMIT
I BUILDING DEPARTMENT Applicant FlLL o�NE (� SC NUMBER 750 1"3
PERMIT APPLICATION
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ADDRESS b � G` Z
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NAME�OR NAME OF BUSINESS)
ACTUAL LOT AREA TOTAL BLDG. AREA
CITY
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REAR
fJ L 1'+
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LEGAL LOT VARIANCE un CONDITIONAL USE
0 YES Ej NO PERMIT NUMBER
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' AILINGG ADOBES"
EXIBTIN6 STREET R/N ............FT. DEFICIENCY THIS PROPERTY
C TYTELEPHONE
NAME -
NUMBER
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REMARKS
ADDRESS
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NAME
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CHECKED BY
CITY
TELEPHO E NUMBER
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ADDRESS
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ADDRESS b � G` Z
EILMidB BLE ACTUAL
LOT COVERAOl? LOT COVFLOE
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
CITY
REQUIRED YARDS PROPOSED YARDS
FRONT HIDE REAR FRONT tl1DF.
REAR
fJ L 1'+
(' 5
LEGAL LOT VARIANCE un CONDITIONAL USE
0 YES Ej NO PERMIT NUMBER
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DEPT, APPROVAL DAT:
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y'PLANNING
CITY
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STREET 12/W IO
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DEPT, APPROVAL DAT:
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y'PLANNING
CITY
TELEPHONE NUMBER
STREET 12/W IO
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EXIBTIN6 STREET R/N ............FT. DEFICIENCY THIS PROPERTY
NAME -
COMP. PLAN ST. R/W ............FT. ............FT. 99
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REMARKS
ADDRESS
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CHECKED BY
CITY
TELEPHO E NUMBER
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METER 81LE SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER.fd
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REMARKS e
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Legal Description of Property (Show Below or Attach Four Caples)
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FIRE ZONE TYPE OFC NBTRUCTION STREET IMPROVED
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YE9 C3 NO
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SPECIAL INSPECTOR REQUIRED GROUP
RESIDENTIAL ❑ GAB
LINE
(OCCUPANCY
YES '�'.�-70 X11•
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PLAN CHECKED D SITENIS LOCATED IN THE CITY
OF E SALES TAX
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NEW ❑THIS
NON-RESIDENTIAL ❑ SIGN
SHOULD BE CODED 31.04.
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ADD RETAINING
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REMARKS
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ALTER EXCAVAFILLTE FENCE
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REPAIR 11 PRE -h OVE ❑ awl
INBP. POOL
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NUMBER OF STORIES
NUMBER OF
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
Valuation Fee ReCCipl No.
Plan Check No .....................
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BUILDING
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OP09ED USE '
PLUMBING
QPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
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FENCE
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RETAINING WALL
BWIMMIN6 POOL
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DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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1 hereby acknowledge that
TOTAL AMOUNT DUE
I have rend this application; that the 1n-
[ormatlon given Is correct;
and that I a n the owner, or the duly author -
(zed agent of the owner. I agree
to comply with city and state lawn rag¢-
letting den. motion; and In aclog
ATTENTION APPLICATION APPROVAL
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the work authorized thereby, no Dornan
will be employed In violntion of Ne Labor
Code of the State of Washington
relating to Workmen's Compensation Ioauranee
TIUS I-ER311T This application is not a permit until
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AUTHORIZER
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DF.MOLITION9 which
ONLY THE
uty; and fees are paid, and receipt is ac -
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shall be completed In ninety day.; MOVED -IN BUILDING. shall be cord.knowledged
WORK NOTED
in
pleted In six months.)
space provided.
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SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION DIRECTOR'S SIGNATURE
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DEPARTMENT
CITY OF
NOTE: Applicant Subject to Plan Check Pee
DATE
EDMONDS ,1 /
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This 1'ermlt covers work to be done oa private property O,yLY
775.2525 .-
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Any construction an ilio public domain (curb., sidewalks, driveways,
marquees, etc.l will r".h. separate permission.
INSPECTOR
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