750301.pdfI
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BUILDING DEPARTMENT Applicant Fin °NE PERMIT 750301
PERMIT APPjiICATI0N I Inside Heavy Lines
N E R E UBINEBBJ
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TELEPHONE NUMBER
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J'NAIIE
W ADDRESS
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ADDRESS d ��- - �6 =' P� . �,✓
PERMISSIBLEACTUAL
F.
IAT COVERAGZ. LOT COVERAGE
PERMISSIBLE HEIGHT PROPOSED HEIGHT
ACTUAL LOT AREA TOTAL BLDG. AREA
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT BIDE REAR
LEGALLOT VARIANCE OR CONDITIONAL USE
YEB [] NO PERMIT NUMBER
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER{'
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STREET R/W
EXISTING STREET R/W ............FT.
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DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN ST. R/W ............FT.
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REMARKS
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER{'
STREET R/W
EXISTING STREET R/W ............FT.
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DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN ST. R/W ............FT.
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REMARKS
ADDHES
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ICHECKED BY
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TELEPHONE NUMBER
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METER S1ZK SERVICE SIZE CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
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PERO. TEST
PERMIT NUMBER a
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FIRE ZONE OF CONSTRUCTION STREET IMPROVED
ITYPE
[].YES [] NO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
OAS
LINE
❑ YES NO
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❑0
NEW
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
0 ADD
KING
REMARKS
SHOULD 9E CODED 31. 4,
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El DE1110LISH r-1RWETAALL
ALTER TD 7
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OR FILL
OR FILLEl (:t.N.. z.•..7...._Ft.)
REPAIR PRE-INSP. ❑
❑ POOL
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NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF NO O HE DONE
V.1—tion
Fee Receipt No.
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Plan Check N
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BUILDING
PROPOSED UBE
PLUMBING
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aPLOT
PLAN (Indicate Building setback., abutting street.)
HEAT k GAS LINE
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FENCE
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SIGN
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RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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TOTAL AMOUNT DUE
Ihereby acknowledge that I have read this aDPllcatlon; that the In-
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formation glven Ie correct; and that I am the owner, or the duly author-
ized agent o[ tha owner. I agree to eomDlY with ally And stale laws rcgu•
ATTENTION
APPLICATION APPROVAL
lating construed..; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
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Islatmg to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is Be -
.hall bac n nlbely days; 11107 D -IN BUILDINGS shall be com•
knowledged in apace provided.
piste six moat
,t
Sl ATURE (O N )
DATE 81GNED
INSPECTION
D OR'S a AT•)1 -" +•"" -• '
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DEPARTMENT
A
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
DATE
775-2525
ThlePermit c, n work to bn done an private property ONLY.
Any cons,ntclian on Ilia public domain (curbs, eldewNks, drN'ewys,
ison.
marquee., etc.) will require separate permd
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