750227.pdfSIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
BUILDING DEPARTMPERMIT
ENT Fill
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AppHmnt
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I hereby acknowledge that I have read this aDPllcntlan; that the In-
PERMIT APPLICATION Inside Heavy Lines
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formation given Is correct; and that I am the owner, or the duly author.
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ADDRESS 1176,
17
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 Deraon
ATTENTION
APPLICATION APPROVAL
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NAME (OR NAME OF BUSINESS)
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This application is not a permit until
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relating to Workmen's Compensation Inaurance.
AUTHORIZES
signed by the Building Official or his Dep -
ACTUAL yy
ONLY TILE
WORK NOTED
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shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn•
lfnowledged in space provided.
LOT COYERAOE 2�-"D1D LOT COVE1tA0E
LOT COVERAGE
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pleted In six months.)
SIGNATURE (OWNER OR AGENT)
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PERMISSIBLE HE T PROPOSE➢ HEIGHT
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DEPARTMENT
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CITY of
NOTE: AhPlicant Subject to Plan Check Fee
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TELEPHONE NUMBER
ACTUAL LOT AREA T TAL BI.UO. AREA
Win imulctC--D t�UC iND�G{(T�O
775-2525
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This P rmit covers work to be don. on private Property ONLY.
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REQUIRED YARDS PROPOSED YARDS
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NAME
FRONT BIDE REAR FRONT BIDE REAR
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CHECKED BY
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TELEPHONE NUMBER
METER tlIZE SERVICE 8175E CLEARANCE
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STATE LICENSE NUMBER
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REMARKS
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Legal D—rlPtl1on of (Show Beiowl or Attach Four Copies)
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FIRE ZONE TYPE OF CONST ON STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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NEW ElLINE
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PLAN CHEC 'D HY THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL
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SIGN
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nnD RETAINING
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REPAIR PRE-MOVESWIM
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONEvaluation
Fee Receipt No.
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BUILDING
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PLUMBING
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PI:O PLAN (2 lento Building setback., abutting streets)
HEAT A GAS LINE
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SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL.
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this aDPllcntlan; that the In-
formation given Is correct; and 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 Deraon
ATTENTION
APPLICATION APPROVAL
-
will be employed In violation of the Labor Cade of the Stale of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Inaurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except IIE51OLITIONS which
ONLY TILE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In ninety days; MOVED -IN BUILDINGS shall be corn•
lfnowledged in space provided.
pleted In six months.)
SIGNATURE (OWNER OR AGENT)
DATE BIGNEU
INSPECTION
D T 'S 8 NATURE
t o
DEPARTMENT
/
CITY of
NOTE: AhPlicant Subject to Plan Check Fee
EDIVIOND3
ATE
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775-2525
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This P rmit covers work to be don. on private Property ONLY.
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Any eanetfuctlan man it.. Public d,mtm (curbs• sidewalks, drlvewga,
nrquess, etc.) will regWre separate permiselon.
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PERMIT APPLICATION I Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)
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LOT COVERAGE LOT COVERAGE
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DEMOLISH WALL
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❑ REPAIR ❑ PRE -MOVE El awl M
INSP. POOL
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REQUIRED YARD9 PROPOSED YARDS
DWELLING
NAME
FRONT BIDE REAR SIDE REAR
,�FFR�O�NT
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LEGALi LOT VARIANCE OR CONDITIONAL USE
Valuation
Fee Receipt No.
[+ ADDRESS
YES ❑ NO PERMIT NUMBER
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TELEPHONE NUMBER
PLUMBING
STREET H/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
HEAT d: GAB LINE
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COMP. PLAN ST. R/W ............FT. ,...........
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REMARKS
PENCE
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SIGN
CHECKED BY
CITY
TELEPHONE NUMBER
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SWIMMING POOL
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METER SIZESERVICE
812E CLEARANCE
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CHECXED HY
STATE LICENSE NUMBER
I CITY LICENSE NUMBER
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EXCAVATION OR FILL
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SPECIAL INSPECTOR REQUIRED
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GAS
❑ LINE
❑ YES [
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❑ NEW
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PLAN CHECKED,VY
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THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SICN
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% (irJ:I/ (•f;,-�✓
OF EDMONDS. LOCAL SALES TAX
31.04.
❑ ADD
RETAINING
4MARKSj
SHOULD BE CODED
DEMOLISH WALL
❑ ❑
EXCAVATEFENCE
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F-1OR FILL ❑ (.......... x .......... Fl.)
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❑ REPAIR ❑ PRE -MOVE El awl M
INSP. POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
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NATURE OF WORK TO BE DONE i
Valuation
Fee Receipt No.
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F „ f / •- A% �- 1,4 i 5 AJC i . hl rP
Plan Check N. .....................
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BUILDING
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SHOP BED USE
PLUMBING
C PLOT PLAN (IndicatC T,ilial ng back , b t[In6 attests)
HEAT d: GAB LINE
21
PENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this appllcatlon; that the In-
V
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized 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 Insurance.
AUTHORIZES
signed by the Building Official Or his DGp-
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY THE
,YORK NOTED
uty; and fees are paid, and receipt is ac -
shall be completed In Waely day.; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six month..)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRE TOR'S SIGNATURE 1 i,
I //
DEPARTMENT
/ 1
CITY OF
EDDIONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
—
This Permit covers work to be dans on private property ONLY.
Any construction on the public domnln (curbs, sidewalk., driveways,
INSPECTOR
marquee., t..) x111 require .eburnte pernd.6lon.
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