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TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
77 (o- 6738 REQUIRED YARDS PROPOSED YARDS
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NAME FRONT SIDE REAR FRONT SIDE REAR
BUILDING DEPARTMENT
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PEILV IeBIIILE HEIGHT PROPOSED HEIGHT
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TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
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NAME FRONT SIDE REAR FRONT SIDE REAR
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SIGN
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ADDRESS LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES E3 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:'
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STREET R/W
NAME EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
OMP. PLAN BT. R/W ............FT. ............FTs
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DEMOLITION
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EXCAVATION OR FILL
CHECKED BY
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TOTAL AMOUNT DUE
CITY
TELEPHONE NUMBER
I hereby acknowledge that I have read this application; that the In.
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METER SIZE SERVICE SIZE CLEARANCE(
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CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUME31
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APPLICATION APPROVAL
will he employed In violation of the Labor Code of the State of Washington
REMARKS
This application is not n permit until
ralntlag to Workmen's Campeneatlon INn[anu.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
Legal Description of Property (Show Below or Attach Four Cuple.) /V t t A
utyi and feed are paid, and receipt Is ac.
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TYPE CONNECTION yERIF1ED BY
knowledged in apace provided.
pleted in six menthe.)
(O111N OR AG T) DATE SIGNED
INSPECTION
DIRECTO t'8 a USE
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PERC. TEST PERMIT
94
NUMBER
CITY OF
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EDMONDS
DAT' /
NOTE-: Applicant Subject to Plan Check Pee
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REMARKS ^
775-252S
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Any construction on the public domaln (curbs, eldew•Nke, delvewaye,
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F1�NE TYPE OCOSSTRUCTILON STREET IMPROVED
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❑ YES C] NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
❑ GAS ❑ YES �] NO I —/=-- Z
RESIDENTIAL LINE PLAN CHECKED DY
El NEWLIS THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL1:1 SIGN OF EDMONDS. LOCAL SALES TAX
❑ ADD SHOULD BE CODED 31 04',
ElDEMOLISH ❑ WAIMNC REMARKS
ALTER EXCAVATE FENCE ,HCl• -L W6r� POL UMC- 177 7 S
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OR FILL (..........z..........Fl.)
REPAIR ❑ INSP. PRE -MOVE O am I
POOL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATUWORK TO HE DON
Valuation
Fee Receipt No.
Q.LQ-.� 1 ..( A/�iw.L�LiL• Plan Check No .....................
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PLOT PLAN (Indicate Building setbacks, abutting streets) BEAT A GAS LINE
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RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
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TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In.
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[ormntlon given iscorrect; and that I am the owner, or the duly author.
Irrd'sent of the owner. I agree to comply with city and .late law. rogu-
ATTENTION
Hating construction; and 1. doing the work authorized thereby, no person
APPLICATION APPROVAL
will he employed In violation of the Labor Code of the State of Washington
TIUS PERMIT
This application is not n permit until
ralntlag to Workmen's Campeneatlon INn[anu.
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
utyi and feed are paid, and receipt Is ac.
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.hall be completed In ninety day.; MOVED -IN BUILDINGS shall be cora-
knowledged in apace provided.
pleted in six menthe.)
(O111N OR AG T) DATE SIGNED
INSPECTION
DIRECTO t'8 a USE
LTURE
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DEPARTMENT
CITY OF
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EDMONDS
DAT' /
NOTE-: Applicant Subject to Plan Check Pee
This 1'rnnit coven work to he done on private property ONLY.
775-252S
Any construction on the public domaln (curbs, eldew•Nke, delvewaye,
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