750195.pdfI
USE PERMIT 750 195
BUILDING DEPARTMENT Applicant Applicant Fill ZONE�v �/j NUMBER 1
�- PERMIT APPLICATION Inside Ileavy Lines L
NAME (OR NAME OF BUSINESS)
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CITY TELEP ONE NUMBER
NAME
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ADDRESS
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PERMISSIBLE J ? ACTUAL
LOT COVERAGE / LOT COVERAGE
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•J�PROPOSED HEIGHT
PEKAUSSIBLE HEIOIITr1-��'
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ACTUAL LOT AREA TOTAL BLDG. AREA
CITY TELEPHONE NUMBER
REQUIRED YARDS PROP08ED YARDS
FRONT REAR FRONT SIDE REAR
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EGAL LOT VARIANCE OA ONTIONAL E
YES NO PERMIT NUM R
Valuation
PLANEP APPR LApe DAT
Receipt No.
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CITY TELEPHONE NUMBER
STREET /W O
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BUILDING
NAME
EXISTING STREET R/ DEFICIENCY THIS PROPERTY
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L PROPOSED USE
COMP. PLAN ST. R/W .50AQ •��•FT•
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PLUMBING
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REMARKS Driveway slopes not to eeceed those
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ADDRESS
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indicated on Standard Dwg. No. 103 w
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RETAINING WALL
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Legal Description of Property (Show Below or Attach Four Copies)r
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TYPE CONNECTION VERIF B
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this eppllcallon; that the in.
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format(on 1
given . correct; and that I am the owner, or the duly author-
FIRE ZONE TYPE OF CON7CTION STREET IMPROVED
a
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,
l:ed agent of the owner. I agree to comply with city and stale laws regu.
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the work authorized thereby, no person
S• ,-. '�'1 %
SPECIAL INSPECTOR/jIDQUIRED OCCUPANCY GROUP
rvlll employed (n violation of the Labor Code of the State of Washington
TIDE PERMIT
(moi
III,�JJ'jj7 IY�I RESIDENTIAL
GAS
❑ LINE
❑ YES d/1G0 � � /
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signed by the Building Official or his Dep -
NEW ///❑"""
NOTE: Permit Limit One Year (Except DEMOLITION8 which
PLAN CH CK D D THIS SITE I LOCATED IN THE CITY
uty; and fees are paid, and receipt Is ac -
NON-RESIDENTIAL
SIGN
J OF EDMONDS. LOCAL SALES TAR
ILD EE CODED 31.04.
pleted In six month..)
nun
RETAINING
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SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEMOLISH
ALTER EXCAVATE
FENCE
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OR FILL
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CITY OF
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REPAIR PRE-TIOVE
INSP.
SWIM
POOL
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NOTE: Applicant Subject to Plan Check Pee
NUMBER OF STORIES NUMBTEER OF
' — -7
1
775-2525
DWELLING
2 U NI
/
ThlePenult r n work to be don n prlvste property ONLY.
1
Valuation
Fee
Receipt No.
;
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Plan Cheek No .....................
BUILDING
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L PROPOSED USE
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PLUMBING
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.� PLOT PLAN (Indlcato Building setbacks, abutting Streets)
HEAT k GAS LINE
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FENCE
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RETAINING WALL
N
6
SWIMMING POOL
DEMOLITION
1
PRE -MOVE INSPECTION
i
EXCAVATION OR FILL
-
1
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this eppllcallon; that the in.
z
/J </
format(on 1
given . correct; and that I am the owner, or the duly author-
,
l:ed agent of the owner. I agree to comply with city and stale laws regu.
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the work authorized thereby, no person
rvlll employed (n violation of the Labor Code of the State of Washington
TIDE PERMIT
This application is not a permit until
,as
.
relating to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITION8 which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt Is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com.
knowledged in apace provided.
pleted In six month..)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
R R' SliNATO E
I
M
DEPARTENT
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CITY OF
F
EDMON
ATE
NOTE: Applicant Subject to Plan Check Pee
' — -7
775-2525
ThlePenult r n work to be don n prlvste property ONLY.
Any ronstruellen an the public domain (curb,, e(dewalks, driveways,
'
marquee,, eir.) will require separate permisslon.
FILE
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USE /� PERMIT ' 1 �'•' 1 I
BUILDING DEPARTMENT Applicant Fill ZOO '�� , NUMBER
PERMIT APPLICATION
Inside Heavy Linos IOD
ADDR
NAME (OR NAME OF BU81NE88) f i • "c''r�
[ / PERNISSIBLE J ? ACTUAL1
�[• /{jam LOT COVERAGE / LOT COOT COVESYAOE �1 •1
M/� NO ADOREHB PERMISSIBLE HEIGIITZ;Z, r--, I P/tOPOeED HEIGHT ^� 1
Plan Check No .....................
O CITY
TELLEPIj NE NUMHEft
ACTUAL LOT AREA �y TOTAL BLDG. AREA I r
A/ , /i �•'(� {j .5�
/:, , S _ /, �5 n
REQUIRED YAItDB PROPOSED YA-5
L,
AME
PROPOSED USE
FRONT SIDE REAR FRONT SIDE REAR
SPECIAL INSPECTOR REQUSRED
OCCUPANCY GROUP
2G� EZ� ?� ► O � �
j�
IlV RESIDENTIAL
❑
I.,EOAL LOT VARIANCE OR COND TiONAL [I.E
N ADDRESS
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f.II _ES [3 NO PERMIT NUMMR
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HEAT A GAS LINE
PLANKPT1 APPR L ` ] AT
C CITY
TELEPHONE NUMBER -
"•
T—
STREET R/W y
SIGN
•EXISTING STREET R/W _:). . .. DEFICIENCY THIS PROPERTY
NAMEJ/�
ADD
COUP. PLAN ST. R/W .-K.�g a'Wc ....C.�.l
( -r-/ 4 .�y
/ 04
REMARKS Driveway slopes not to eRceed those
ADDRESS/
indicated on Standard Dwg. No. 103
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EXCAVATE
CHECK D HY
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ft 1TY .-
T,ELEP NU/M13ER/
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C Y LICENSE NUMBER
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/Properttyy
NUMBER OF
RE RKS
PRE -MOVE INSPECTION
(Show Below or Attach FOur Copies)
Legal Description of Property (Show Below or Attach FOU Copies )Description of
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DWELLING
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TYPE CONNECTION VERIFIED 8 f [ •?'.
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UNITS
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�+
PERC. TES PER
M EA
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Valuation
Fee Receipt I
Ized agent of the owner. I agree to comply with city and elate laws regu-
N
O
FJ
RIM $
i, '/
-
will be employed in Violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
Plan Check No .....................
I
/.11� I _1C - IV
I �rES ❑ NO
PROPOSED USE
SPECIAL INSPECTOR REQUSRED
OCCUPANCY GROUP
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j�
IlV RESIDENTIAL
❑
GA1a
LIxE
❑ YES
I
Jam( NEN
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HEAT A GAS LINE
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- G•✓G
PLAN CHECKf ,D Il _
1 /
OF SITE IS 5.O LOCAL SALES TAX
T—
NON-RESIDENTIAL
SIGN
��(��• / 1f G�
SHOULD BE CODED 3L,04.
ADD
DEMOLISH
❑
RETAINING
WAIT'
RE K
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❑❑
EXCAVATE
FENCE
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I J L G!✓/ / �C ION
ALTER
OR FILL
(..........s.......... Ft.)
REPAIR
PRE -MOVE
INSP.
D
POOLI
POOL
<�(%,�`,�-%'/' Ir.-.� /�
%% .S//C/�✓�/E.''G /%u/✓1
YUMBER OF STORIES
NUMBER OF
PRE -MOVE INSPECTION
DWELLING
fir%
UNITS
/
;MATURE OF WORK TO BE DONE
/
Valuation
Fee Receipt I
Plan Check No .....................
I
O
BUILDING
PROPOSED USE
PLUMBING
aPLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
'.1 (
- G•✓G
Z-1
SIGN
j
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
O In-
I hereby acknowledge that I have rend this application; that the
/
foreantlon glV iscorrect; sad that I am the owner, or the duly author.
Ized agent of the owner. I agree to comply with city and elate laws regu-
lating construction; and In 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 Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is an
shall be completed In ninety days; MOVED -IN BUILDINGS shall be win.
knowledged In space provided.
plated In els months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
D R CTOR-8 HIGNATUP
DEPARTMENT
.'� 1
1`
(
i�' i�'"%r-,.�te.J/i�2-�_/•
CITY OFEDMONDS
(_�
NOT
(
t
_
775-2525
his Permit conn work to be done on prlvste property ONLY.
A.eonetruetlon on the public AOmaln (curbs, sidewalks, drlvewve,
INSPECTOR
I
areueee, elC.l will rwnire separate permleelon.
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