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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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PLAN HEC E DY THIS SITE IS LOCATED IN THE CITY
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❑ NON-RELIDENTIAL
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OF EDMONDS. LOCAL SALES TAX
SHOULD B CODED 31.04.
❑ ADD
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BUILDING DEPARTMENT
AppHeant FlH
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❑ REPAIR PRE-h10
❑ INSP.
VE SWIM
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PERMIT APPLICATION
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ADDRESS
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PERMISSIBLE LOTUAL
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TELEPHONE NUMBER
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LEGAL LOT VAii ANCE ON CONDITIONAL USE
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PLANNING DEPT. R DATE:
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TELEPHONE NUMBER
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DEMOLITION
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ADDREtlS
EXCAVATION OR FILL
indicated on Standard Dwg. No. 103
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TOTAL AMOUNT DUE
CITY
TELEPHONE NUMBER
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M 0'L' SERVICE BILE CLEA ANCE
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loGnation given le correct; and tb t I am the owner, or the duly author.
STATE LICENSE NUMBER
I CITY LICENSE
CTER
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lnting construction: and In doing `he work authorized thereby, no person
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THIS PERMIT
REMAIUCS
relating to workmen's Compeneall o Insurance,
AUTIIOBIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One ear (Except DEMOLITIONS which
Legal Description DI Property (Show Below or Attrteh Four Copies)
GGA
shot] be completed In ninety days; LIOVED-IN BUILDINGS shall be coin•
knowledged In space provided,
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YPE CONNECTION VERIFID Y
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DATZE'8I1GNEU
INSPECTION
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EDAIONDS
REMARKS
NOTE: Applicant S)�hject to Plan Check Fee—
a
775-2525
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
Title t'ennit raven work to be done an private properly ONLY.
Any conetructinn on the public 4ontaln (curb@, eldew'nlks, drlvew"s,
-4!L•— I / _/V W -YES C] NO
Ilan Check No .....................
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
E]YEB t_ 'j /
RESIDENTIAL
GAS
❑ LINE
C
PLAN HEC E DY THIS SITE IS LOCATED IN THE CITY
NEty
❑ NON-RELIDENTIAL
❑ emN/
OF EDMONDS. LOCAL SALES TAX
SHOULD B CODED 31.04.
❑ ADD
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RETAINING
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❑ PENCE
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❑ REPAIR PRE-h10
❑ INSP.
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IUMBER OF STORIES ri.MBER
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Valuation Fee Rcccl
iATURE Oi WORK 'y'O HE DO
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Ilan Check No .....................
BUILDING
4 PROPOS
• D USE
✓`�-' V Y-G�
PLUMBING
PLOT P
AN (Indicate Building sotbacke,
abutting streets)
HEAT A GAS LINE
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PENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
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DEMOLITION
PRE-MOVK INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
Ihereby acknowledge that I imve rend this application; that the In-
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loGnation given le correct; and tb t I am the owner, or the duly author.
Ized ngont of the owner. I agree tl� ce, will city and state Tawe MIR-
ATTENTION
APPLICATION APPROVAL
lnting construction: and In doing `he work authorized thereby, no person
will be employed In violation at lite Labor Code at the State of Washington
THIS PERMIT
This application is not a permit until
relating to workmen's Compeneall o Insurance,
AUTIIOBIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One ear (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
shot] be completed In ninety days; LIOVED-IN BUILDINGS shall be coin•
knowledged In space provided,
pl
d In elx moat s.)
E OI
DATZE'8I1GNEU
INSPECTION
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EPADRTMENT
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EDAIONDS
DATE
NOTE: Applicant S)�hject to Plan Check Fee—
74"
775-2525
Title t'ennit raven work to be done an private properly ONLY.
Any conetructinn on the public 4ontaln (curb@, eldew'nlks, drlvew"s,
FILE
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mo'_ ele.)
quire sepnrnte perneledon.
Stu �s
56
MAN, POIN . l60 t'14'
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough) LL--
Frame
Furnace & Fuel Lines
Final