750264.pdf(
BUILDING
DEPARTMENT Applicant Flli
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Inside Heavy Linos
PERMIT APPLICATION I
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ADDRESS 4 I ."a//_ o 22�_
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NAME (Oft NAII OF f1UBINE6 )
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PERMI88IOLE 7 ACTUAL r'
LOT C,OVERAOE 10 LOT ..VE AGE IJ
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MAILING ADDRESS /
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TELEPHONE NUMBER
ACTUAL LOT A�/R/�EAATOTA/1� LDO.
RF.gU1It ErD'YARDN PROPOSE. YARDS,4 AQPM
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FRONT 8IDE REAR FRONT SIDE REAR
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LEOAI, LOT VARIANCE Oli CON D2fiIONAL UeE
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YES ❑ NO PERM1IIT NUM1mER
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(LTELEPHONE
CITY NUMBER
R/ {
STREET
EXISTING EET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDRESS
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CHECKED BY
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CITY
I TELEPHONE NUMIIER
VMETER
1112E SERVICE SIZE CLEARANCE
CM CKED BY
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STATE LICENSE NUMB -ERI
CITY LICENSE NUMBEli
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
YPE CONNECTION VERIFIED BY
PEItC. TEST PERM1[IT NUAI
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FIRES �ZON�ETYPE OF CONSTRTJCTION STREET IM1IPROVED
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑ ❑ GA8
NEW RESIDENTIAL LINE
YEa D-/
❑ PLAN CHECKE BYJ THIS SITE IS LOCATED IN THE CITY
OF EDMON DS. LOCAL SALES TAX
NON-RESIDENTIAL ❑ SIGN
ADD RETAINING
RE A xs-�-`"�' H LD BE CODED 31.04.
DEMOLISH WALT
EALTER EXCAVATE FENCE
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❑ OR FILL C L...7'c-x.,........Ft.)
REPAIR PRE -MOVE SWIM
INER 1:1POOL
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NUMBER OF STORIES NUMBER OF
LING
UNITS
N= OF�ORK TO BE^DOONE
Valuation Fee Receipt No.
0 /Y/ /l.Opi moi' / (j /-/�✓���.(a
elan Cbeck No ............
BUILDING
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PROPOSED USE
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PLUMBING
U
aPLOT
PLAN (Indicate Building eetbaclia, abutting streets)
HEAT A GAS LINE
FENCE
SIGN
tRETAINING
WALL
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N
SWIMMING POOL
DEMOLITION
=
PRE -MOVE INSPECTION
EXCAVATION OR FILL,
TOTAL AMOUNT DUE U�) I
I hereby acknowledge Last 1 have read this application; that the In.
formntlan given Is correct; and that I she the owner, or the duly author-
7xed agent of the owner. I agree to comply with city and state laws reg.-
ATTENTION APPLICATION APPROVAL
'
Iating 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 Ineurenee.
AVTIIORIZES signed by the Building Official or his Dep -
NOTE: Permit limit One Your (Except DEMOLITIONS whlch
ONLY TIIE
WORK NOTED uty; and fees are paid, and receipt Is ac -
shalt be completed In ninety days: MOVED -IN BUILDINGS shall be cum-
knowledged In space provided.
pleted In six months.)
-
BIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION 1R R'11 [ONATURE
DEPARTMENT
Jl'�1IGC-
CITY OF 11
NOTE: Applicant Subject to Pfaff Check Fcr
DATE
ED1
775-25255-2525
This1'ennit a ren work to b. don. on private property ONLY.
Any construct,.. on On, public domaln (curbs, Ad—alk., driveways'
FILE
marquees, rte.) will require s'parale permission.
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Legal Description of Property tnnOw Below or Armen lour uopleel
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BUILDING DEPARTMENT
US PERMIT
ZONE: (� — NUMBER
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Applicant Fm
PERMIT APPLICATION Inside Heavy Lines
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ADDRESS'. / i• I / �/ /J/ ('1 i,. ..yGCi �,�,1 f
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NAME (OR NAME OF BUSINESS)
PERMISSIBLE % / ACTUAL
IAT COVERAGE �,.� of LOT COVE AGE 3/I J
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MAII.INO ADDRESS
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PERM [eSIBLE HEIGHT / PItOPO U HEIGHT
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REMAR 9
CUT Y TELEPHONE NUMBER
ACTUAL LOT AREA - TOTA I% LUG. A�tgA
AREA ,L �jr r=/-7 r.).
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REQUI ED YARU9 PROPOSED YARDS
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NAME
FRONT BIDE REAR e1DE REAR
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LEGAL LOT VARIANCE OR CONDIfiIONAL UBE
yU,l
ADDRESS
YES 0 NO PERMIT NUMBER
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CITY TELEPHONE NUMBER
/V/ [ILY�B/ NO
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STREET R/
EXISTINGT EET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN 8T. R/W ............FT. ............FT.
RESIDENTIAL
❑ OAS
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REMARKS
NEW
LINE
PLAN CHECKE B
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Legal Description of Property tnnOw Below or Armen lour uopleel
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!TYPE CONNECTION
VERIFIED BY
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PERC.
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REMAR 9
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FIRENE TYPE OF CONSTRYCTION BTREET-11IP❑ROVED
/V/ [ILY�B/ NO
SPECIAL INSPECTOR REQUIRED OCCUPANCYGROUP
RESIDENTIAL
❑ OAS
'`
❑ YES R,NIS
I d
NEW
LINE
PLAN CHECKE B
_
THIS SITE IS LOCATED IN THE CITY
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NON- RESIDENTIAL
sxcN
OF EDMONDS. LOCAL SALES TAX
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ADD
RETAINING
..�
R %A Ki
HOULD BE CODED 31.04.
DEMOLISH WALL
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EXEl F(.'..Nc.E
El CAVATE FENCE
ALTER
/
GU/L(,J�(/C/ (J/tJ C% % %•j
EJ OR FILL
❑PRE -MOVE SWIM
REPAIR ❑ INSP. ❑ POOL
i_.•/"�//�/C-��}� iffr��%�//T'�S(J�U/ /C/
NUMBER OF STORIES NUMBER OF
DWELLIN6
UNITS
NATURE OF WORK TO BE DONE
VD.Iuatlan
Fee Recelpl No.
'. :`:. )';.h. ': .(t f l._ /_,r //A-� �.c�%(.%
Pinn Check No .....................
7.
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PROPOSED USE
�q
PLUMBING
O
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
e7
FENCE
SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
—Ul%
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this apiellcnllon; that the in.
G "'-
.,motlon given 1. correct; and that I am the owner, or the duly aulhor-
Ized agent of the owner. I agree to comply with city and state Iowa regu-
ATTENTION
APPLICATION APPROVAL
Iating construction; and In doing the work authorized thereby, no person
will be empleyed In vlolntlon of the Labor Code of the State of Washington
TIDE PERMIT
This application is not a permit until
i
relating to Workmen's Compensation Imucance.
AUTIIORIZES
signed by the Building Official Or his Dep-
I
NOTE: Permit Limit One Year (Except DEMOLITIONS whleh
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac
-
.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be cam-
knowledged In space provided.
pleled In six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
- -
INSPECTIONIREF'f4A's
DEPARTMENT
�1GNA
� TURE
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CITY OF
ED51OND3
ATE y
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NOTE: Applicant Subject to Pian Cbeck Fee
775-2525
TWs Parnllt e.— work to bo done on print. properly ONLY,
Any construction oil Ill. publlo domain (eurbe, sidewalks, rill-wa)s,
INSPECTOR
...rpuee., .tc.) will reamre separate permieslun.
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75oz&y
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RECORD OF INSPECTIONS
Date Passed
_
Foundation
Plumbing (Partial)
(Rough)
Frame
Furnace & Fuel Lines
Final