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USE PERMITI
BUILDING DEPARTMENT Applicant FiU
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�-° PERMIT APPLICATION I Inside Heavy Lines
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NAME (OR NAME OF BUSINESH)
PEI;h1ItltlIBLE U ACTUAL
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LOT COVERAGI T LOT COVF.SYAGE
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MAILING ADDRESS
PEltJlltltlIBLE HFIGIIT PROPOSED HEIGHT,G•�%- 4
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ACT.A1 LOT A EA TOTAL fIILUO •AREA
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LEGAL CO OITIONAL USE "OT VARIAN OH
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REMARKS Driveway slopes not to exceed those
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indicated on Standard Dwg. No. 103 W
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TELEPHONE NUMBER
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
GAS
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NEW
PLAN CBEC ED DY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
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DED 31.04.
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ADD
RETAINING
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DEMOLISH WALL
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EXCAVATE FENCE
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❑ REPAIR ❑ INSPPRE-. SWIM
O POOL
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NUMBER OF STORIES NUMBER Oil
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fcc necelpl No.
Plan Check N......................
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BUILDING
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PROPOSED USE
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PLUMBING
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PLOT PLAN (Indicate lud kingng setbacks, abutting streets)
HEAT A GAS LINE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
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PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DILE
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I hereby acknowledge that I have read this application; that the In-
formation given le correct; and that I and the owner, or the duly aulhor-
Ized elect of the owner. I agree to comply with city and state laws mgu-
ATTENTION
APPLICATION APPROVAL
lades construction; and In doing the work aulhorlzed thereby, no yerson
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 Insurance.
AUTHORIZES
signed by the Bullding Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITION8 which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is as
-hell be completed In nln-ly day.; MOVED-IN BUILDINGS shall he com-
knowledged in space provided.
pletcd In six months.)
SIGN URE (OWNER OH AGENT)
DATE IIIGN1113F
INSPECTION
1
DIRECT R'S B .� UI;E
DEPARTMENT
CITY OF
EDMONDS
DATE
-
NOTE: Applicant Subject to Plan Check Fce
775.2525
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Thle Permit eavrre work to be done on private property ONLY.
Any construction on the public domain (curb., sidewalk., driveway.,
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marquee., etc.) Illi rep rare separate percussion.
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Flan Cheek No.....................i
BUILDING
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UBE PERMIT /v.IOZOy
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(Or
Y PROPOSED USE
BUILDING DEPARTMENT Applicant FillZONE(::•;
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PERMIT APPLICATION Inside Heavy Lines
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ADDRESS r - ,•f:. •, ,• t x
NA (OR NAME OF BUSINESS)
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PERMISSIBLE - 7I ACTUAL
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HEAT k GAB LINE
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MAILING ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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TELEPHONE NUMBER
ACTUAL LOT Ak. TOTAL
WALL
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REQUIRED YARUB ! PROPOeED YARUe !
NAME'
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
LEOAI. LOT VARIA OR CONDI' ONAL U
ADDRESS
9YEe , NO 1 PERhfITf �UMHER
I hereby acknowledge, that I have read this application; that the In-
P A N6DEPT. AF PROVAL
'� DATE'
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TELEPHONE NUMBER
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6TREET�R/W /
EXISTING STREET R/W DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN 8T.
TIDE PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance.
REhfAIi1C8 �l i. TIO, LO13 rNc •�•1 tt7n`r ['
signed by the Building Official or his Dep -
it
NOTE: Permit Limit One Year (E -o -pt DEMOLITIONS which
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1 incl lt- l t C i `'I / No 2.00.
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be Som-
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CHECKED BY
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CITY t.,,
TELEPHONE NUMBER
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DEPARTMENT
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CITY OF
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EDMONDS
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SERVICE SHZE CLEARANCE
CHECKED
BY
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STATE LICENSE NUMBER
I CITY LICENSE NUMBER{
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Any construction on thepublic domain (curbs, sidewalks, driveways'
REMARKS
INSPECTOR
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marquees, rtr.) )III regmre separate permission.
Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION VE FIED BY ,
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IPERMIT
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NUMBER
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,ale
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FIRE ZONE I TYPE OF ST UC N S h ROVED
_.IJS 0 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
REBSDENTIAL
GAB
F-1 LINE
❑ YES E3 NO -- /
❑. NEW
PLAN CHECKED,DY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
/' OF EDMONDS. LOCAL SALES TAX
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