750179.pdfNAME
ZONENUMBETR750179PERMIT
FRONT BIDE REAR FRONT BIDE REAR
BUILDING DEPARTMENT
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PPLItATION
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ADDRESS � O / V
PLUMBING
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LOT
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PERMISSIBLE HEIGHT
ACTUAL LOT AREA
PROPOSED HEIGHT
TOTAL BLDG. AREA
CITY
NUMBER
REQUIRED YARDS
PROPOSED YARDS
NAME
Plan Check No..
FRONT BIDE REAR FRONT BIDE REAR
Fee Receipt No.
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LEGAL LOT VARIANCE OR CONDITIONAL USE
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PLUMBING
0 YES F) NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
SPECIAL INSPECTOR REQUIRED
GROUP
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C CITY
TELEPHONE NUMBER
RESIDENTIAL
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C]YE8 [] NO
IOCCUPANCY
STREET R/W
10
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LINE
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
THIS SITE IS LOCATED IN THE CITY
NAME
NON-RESIDENTIAL
............FT. ............FT.
COMP. PLAN 8T. R/W01
W
OH TAX
❑ ADD
REMARKS
ADDHE88 . -.A
y •
REMARK
ULD BE CODED 3LL145ALES
w;
V
PRE -MOVE. INSPECTION
CHECKED BY
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C CITY
TELEPHONE NUMBER
AVATE
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FENCE
ALTER
❑
OR FILL
❑
Iormntlan givem n Is correct; and that I athe owner, or the duly author-
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METER 01LE
SERVICE SIZE
CLEARANCE
CHECKED BY
SWIM
lating construction; and In doing the work authorised thereby, no person
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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id
relating to Workmen's Compensation Imurnnce.
(UMBER OF STORIES
NUMBER OF
----
NOTE: Permit Limit One Year (Except DML
EOwhich
ONLY THE
uty; and fees are paid, and receipt is ac-
iI..77
ehnll be completed In ninety days; MOVED -IN BUILDINGS shall be com-
REMARKS
knowledged in space provided.
plcled In a nth..)
I Legal Description or Property (Show Below
ar Attach Four Copies)
UNITS
INSPECTION
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Plan Check No..
Valuation
Fee Receipt No.
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FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROV.
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PLUMBING
0 YES " NO
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SPECIAL INSPECTOR REQUIRED
GROUP
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RESIDENTIAL
GAS
C]YE8 [] NO
IOCCUPANCY
NEW
10
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❑
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
El
NON-RESIDENTIAL
D
SIGN
OH TAX
❑ ADD
BWIDSMIN6 POOL
RETAINING
REMARK
ULD BE CODED 3LL145ALES
DEMOLISH
PRE -MOVE. INSPECTION
WALL
EXCAVATION OR FILL
AVATE
FENCE
ALTER
❑
OR FILL
❑
Iormntlan givem n Is correct; and that I athe owner, or the duly author-
REPAIR
❑
PRE -NSP.
El
SWIM
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
POOL
relating to Workmen's Compensation Imurnnce.
(UMBER OF STORIES
NUMBER OF
----
NOTE: Permit Limit One Year (Except DML
EOwhich
ONLY THE
uty; and fees are paid, and receipt is ac-
ehnll be completed In ninety days; MOVED -IN BUILDINGS shall be com-
DWELLING
I
knowledged in space provided.
plcled In a nth..)
UNITS
INSPECTION
DI OR'B la NATU .[%
Plan Check No..
Valuation
Fee Receipt No.
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BUILDING
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PLUMBING
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O PLOT PLAN (Indlcato Building aetbneke, abutting streets)
HEAT k GAS LINE
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FENCE
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SIGN
RETAINING WALL
BWIDSMIN6 POOL
�-
DF,DSOLITION
PRE -MOVE. INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In-
Iormntlan givem n Is correct; and that I athe owner, or the duly author-
Ired agent of the owner. I nxrea to comply with city and state laws ngu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorised thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Imurnnce.
AUTHORIZES
eigned by the Building Official or his Dep-
----
NOTE: Permit Limit One Year (Except DML
EOwhich
ONLY THE
uty; and fees are paid, and receipt is ac-
ehnll be completed In ninety days; MOVED -IN BUILDINGS shall be com-
WORK NOTED
knowledged in space provided.
plcled In a nth..)
O US ( VNE 1 OR AO T) DATE SIGNED
r
INSPECTION
DI OR'B la NATU .[%
DEPARTMENT
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CITY OF
a. �(:�,r
EDMONDS
DATE
NOTE: hplicant SRh ect to Plan Check Fee
775-2525
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This Per It cmera aork to be dun n private property ONLY.
Any eonelnlrllnn nn Ihn public dnmoln frurbe, .1,1-1k., drlvew'aye,
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