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BUILDING
DEPARTMENT Applicant FM
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APPLICATION Inside Heavy Lines
PERMIT
ADDHEBB Me o2(9
NAME (OR NAME OF BUSINESS)
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PERMIB018LE
IAT COVERAGE
ACTUAL
LOT COVE AOE
tl MAILING ADDRESS
PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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CITY
TELEPHONE NUMHIf.R
ACTUAL LOT AREA
TOTAL BLDG. AREA
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A 157,01J 7-25 If/,CJ -IJ
7— %-6 3413
REQUIRED YARDS
PROPOSED YARDS
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NAME
FRONT BIDE REAR FRONT BIDE REAR
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LEGAL LOT VARIANCE OR CONDITIONAL UBE
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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
EXI8TIN6 STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
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NAME I'
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COTLP. PLAN ST. R/W ............FT.
............FT.
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RE MARKS
ADDREtle
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BY
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CITY
TELEPHONE NUMBER
(CHECKED
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METER SIZE
SERVICE BILE CLEARANCE
CHECKED BY
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STATE LICENSE NUMBER
KSE NUMBER
CITY LICE'_
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&ARKS
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Legal Description of Property (Show Below or Attach Faur Copies)
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TYPE CONNECTION
VERIFIED BY
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PEItC. TEST
PERMIT NUMBER
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REMARKS
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FIRE Z TYMCONSTRyCTION STREET Ie1PROVED
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I (3YEB Ej No
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SPECIAL INSPECTTOR REQUIRED
OCCUPANCY OR UP
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RESIDENTIAL
GAS
LINE
E]YEB NO
❑ NEW
PLAN CHECKED IIY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
aicx
OF EDMONDS. LOCAL SALES TAX
31.04.
0 ADD
RETAINING
REMARKS
SHOULD BE CODED
DEMOLISH WAIT'
ALTER ❑ EXCAVATE FENCE
OR FILL � (-.........x..........Ft.)
❑ REPAIR ❑ PRE -.LOVE ❑ swill
INBP. POOL
NUMBER OF STORIES NUDIDEFi OF
DWELLING
UNITS
NATURE OF WORK TO HE DONE
Valuation
Fen Receipt No.
Plan Check No .....................
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BUILDING
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PROPOSED UBE
PLUMBING
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PLOT PLAN (Indlcnto Hulltlln6 setbacks, abutting streets)
HEAT @ GAS LINE
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FENCE
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SIGN
RETAINING WALL
eWIMMI146 POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
,
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
at
foration given le correct; and that I am the owner, or the duly author.
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Ized agent of the owner. I agree to comply with city and elate law. regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and to 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 Iasurance.
AUTHORIZE8
signed by the Building Official or hie Dep-
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NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TitE
WORK NOTED
uty; and fees are paid, and receipt is ac -
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shall he completed In ninety days; MOVED -IN BUILDINGS shall be core.
knowledged in space provided.
pleted in six months.)
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tl TURF (OtVNER. OI GENT)DATE SIGNED
INSPECTION
D R'B ATURE
to 7�
DEPARTMENT
CITY OF
EDMON
neTE
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Applicant Fee
NOTE: Subject to Plan Check
775-252525
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This Pemdt covers nc,k to he done on private property ONLY.
:any runat rnrUnn n thr Vnlilir do 1. (curb., sldrwnike, drlcewars,
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