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BUILDING DEPARTMENT SE Z ND r 75015a
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RETAINING
ElDEMOLISH ❑ WALL
Applicant Fill ��S-
PERMIT APPLICATION Inaldo Heavy Linea JOB/;P
ADDRESS
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NAME (OR NAME OF BUSINESS)
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E]REPAIR ❑ INSPhIOVE ❑ POOL
PERMISSIBLE ACTUAL /
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LOT COVERAGE ^��d� LOT COVE,AGE co
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CITY TELEPHONE NUMBER ACTUAL LOARF.A TOTAL BLDG. AREA
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Valuation
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BUILDING
STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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STATE LICENSE NUMBER CITY LICENSE NUMBER
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SIGN
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REMARKS
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Legal Description of Property (dhow Below or Attach Four Copies) j
aQ4_ 1-10 O, 00 / —TYPE CONNECTION VERIFIED BY
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SWIMMING POOL
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� REMARKS
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EXCAVATION OR FILL
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Fl I TYPE OF CTR�ON STREET, IMPROVED
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SPECIAL INSPECTOR RREQUIRED OCCUPANCY GROUP
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I hereby acknowledge that I here read this application; that the In.
TOTAL AMOUNT DUE
GAS [3 YES%--
RESIDENTIAL
❑ NEW❑ ❑ LINE PLAN CHEC ED Y THIS SITE IS LOCATED IN THE CITY
OF EDMONDS LOCAL SALES TAX
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NON-RESIDENTIAL
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ElDEMOLISH ❑ WALL
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E]REPAIR ❑ INSPhIOVE ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
2— UNITS
NATURE OF WORK TO BE DONE
Valuation
Fen Receipt No.
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Plan Check No ......................
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BUILDING
�4 PROPOSED USE
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PLUMBING
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PLAN (Indleale Building setbacks, abutting Streets)
HEAT @ OAS LINE
PENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
1
EXCAVATION OR FILL
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I hereby acknowledge that I here read this application; that the In.
TOTAL AMOUNT DUE
formation given Is correct; and that I am the owner, or the duly author-
ired agent the owner. I agree to comply with city and elate laws regu-
tr
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lating construction; and In doing the wont authorized thereby, no person
will be employed in violation of the Labor Code of the Stale of Washington
THIS I'ERA IT
This application is not a permit until
relating to Workmen's ComReneation Insurance.
AUTHORIZES
signed by the Building Official or his De
Permit Li it One Year (Except DEMOLITIONS which
ONLY TILE
ONLY
WORK NOTED
uty; and fees are paid, and receipt is aC-
shall be completed to Inety days; MOVED -IN BUILDINGS shall be earn-
knowledged !n space provided.
pleted In elx month .
SIONATUItE 101 EIt
DATE SIGNED
3NBARTMEN
DIR OR'
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DEPARTMENT
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C T OF
EDNIOND3 DATE ------
NOTE: Applicant Subject to Plan Check Fee79—
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This Permit toren .it to be APne on private 775-2525 property ONLY. Any construction on tine public domain (Curbs, sidewalks, driveways,
nurquees, ele.1 i0ll require separate Permission. FILE
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BUILDING DEPARTMENT ApplicanF
zoNE NUMB f
PERMIT APPLICATION Ins do IleaYy Linea
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ADDRESS
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ADDRE88 / %
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NAME (Oft NAME OF HUe7NEBB)
ACTUAL
PERMISSIBLE m ACTUAL q
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LOT COVERAOIe ��-r> LOT COVERAGE
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PERMISSIBLE 8 IOIIT PROPOSED HEIGHT O
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CITY
AREA TOTAL BLDG. AREA
CTUAL LOT A
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— REQUIRED YARDS PROPOSED YARDS
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FRONT BIDE REAR FRONT BIDE rREAR. .r
NAME
LEGAL LOT VARIANCE OR CO ------
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ADDRESS
YE 8 0 NO PF.RAIIT NUMBER
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CITY Ant 1 (� TE EPHONE NUMBER
PLANNING DEP ,. I•ROVAL DATj•1:
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E%IBTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. A/W ............FT. ......_....FT.
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REMARKS
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ADDRESS
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CHECKED BY
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CITY TELEPHONE NUMBER
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STATE LICENBD NUafHER
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CITY LICENSE NUMBER
ME/TER/ K
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r E, V' C ' eI2 CLEARANCE
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CHECKED BY
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Legal Deecrlptl D;(� cLI Prape rty (Show Below
or Attach Four G-Plae)
REMARKS
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TYPE CONNECTION �� ERI ED Y
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PERC. TEST P$R N•.,
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REMARKS
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FIRE ZONE TYPE OF CONeTRU-/.- STREET IMPROVED
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Try— I -,v016 ❑ NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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❑' RESIDENTIAL ❑ LINE
❑ NEW ❑
❑YES
PLAN CHEC ED Y % THIS SITE IS LOCATED IN THE CITY
OF EDMON TAX
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NON-RESIDENTIAL a7cx
❑✓ ADDElRETAINING
f'� -;1, .✓;h/t/ HOULD BE CODED 3A04.SALES
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DEMOLISH WALL
.PEMARK
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ALTER ❑
OR FILL (........_x .......... FL)
El
PRE -MOVE SR'I11I
REPAIR ❑ INSP. POOL
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NUMBER OF STORIES NUMBER Oil
DWELLING
z-- UNITS
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NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
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4•! C_I..V Jar:(, � .
Plan Check No .....................
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BUILDING
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PROP013ED USE
PLUMBING
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aPLOT
PLAN (Indicate Building eCtbneke nbrrui ng aL.Ct.)
HEAT A GAS LINE
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PENCE
SIGN
tRETAINING
WALL
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SWIMMING POOL
DEMOLITION
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PRE -MOVE INBPECTiON
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
1 hereby acknowledge that I have read tole application; that the In-
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formation m given le correct; and that I athe owner, or the duly author-
ized agent oL the owner. I agree to Comply with city and elate law. Mail-
ATTENTION
APPLICATION APPROVAL
...... conetructlon; and in doing the work authorized thereby, no portion
Willbe employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a perinit until
relating to workmen'- Cumpeneatlop Imuraace.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit One Year (E.e.Pt DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
-hall be completed In ninety day.; MOVED -IN BUILDINGS shall be Co..
knowledged in space provided.
plated In elx month$:)
SIGNATURE (OWNER OR AGENT) DATE 810NEll
-/ ..
INSPECTION
DEPARTMENT
D1R 8 NATUEIE C OR'� 30
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_ CITY OF--
EDMONDS
DATE k
NOTE: Applicant Subject to Plan Check Fee
'tin / S
775-2525
Thi- Permit covers work to be done on private property ONLY.
Any conetructlon on the pub le domain (Curb', sidewalks, drhoways,
INSPECTOR
marquee., etc.) will require separate permiselon.
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