750325.pdfZONE CO N°�� 75032
BUILDING DEPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS
(OR NAME OF BU3INE88)
1E
PERMI88IIILE ACTUAL
LOT COVERAGE S LOT COVE AGE
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MAILING """IES"
PERMISSIBLE HEIGHT R�•- PROPOSED HEIGHT
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CITY
T-E�ILEPHON. NUMBER
ACfUAVT AREA TOTAL INIJtY� EA
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EQUiRED YARDS OPOSED YARDS
NAME
FRONT BIDE REAR FRONT BIDE RE R
LE LOT RIANCE OR CONDITIONAL UeE 1
EB P RDI IT NUMBER 1
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NNIN6 EPT. A }rAL
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TELEPHONE NUMBER
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STREET/V
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EXISTIN STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. ft/W ............FT. ............FT.
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REMARKS
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ADDRESS
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CIT ^\{^� Tt{E-.-L�EP7�tH2ONE NUMBER
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/CLEARANCE
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ID`c'lS
MEITER SIZE BERjYYyICE SIZE
CHECKED BY
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STA3E L CENBD N DIRER
CITY LICENSE NUMHEN
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REMARKS
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Legal Deelcrlp\tion of Below orAttachFour Copies)
1Property h(Show
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TYPE CONNECTION VERIFIED BY
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PERC. TEST
PERMIT NUMBER
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REMARKS
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FIRE ZONE TYPE OF CONST`R'UCTIONSTREET IMPROVED
WYEB
0 NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
j`�(I NEW
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RESIDENTIAL
GAB
LINE
C]YE8 NO �I
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PLA KED BY THIS SITE IS LOCATED IN THE CITY
TTS\
NON-RESIDENTIAL
❑
OF UIDMONDS. LOCAL SALES TAX
in
❑ Ann
RETAINING
SHO LD OE CODED 31.04.
REMARKS
❑ DEMOLISH
-74065(
EXCAVATE PENCE
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(/�.VA�L 1GIV1I� (4065(
ALTER ❑
(..........z..........Fl.)
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On
REPAIR ❑
NBPMOVE SSWIIhf . POOL
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, 6)A J JVr-E�yi�'1 {�-�✓' = -7 �.r �.[.+c.�/�i'�
L.{)
NUMBER OF STORIES NUMBER OF
lam',
--� DWELLING •��l�'
UNITS
/1. . ,l ' �� J
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N E OF WORK TO HE DONE
Valuation
F c Receipt No.,
-�� l'Tt �U Cy(�1J • —
Plan Chcek No .....................
3f, 60
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Ae.e� �{"'� �C�L
BUILDING
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PROPOSED USE
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PLUMBING
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PLOT PLAN (Indlcnto Hulldln6 setbacks, abutting streets)
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
BWIMMI!YG POOL
DEMOLITION
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PRE -MOVE INSPECTION
EXCAVATION OR FILL
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-
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In.
formation given U correct; and that I am the owner, or the duly author.
lied agent of the owner. I agree to comply with city and state laws regu•
ATTENTION
APPLICATION APPROVAL
Inting conetruetlon; and In doing the work authorised thereby, no person
will be employed In vlolaU.. of the Labor Code of the Slate Of Washington
THIS PERMIT
This application is not a perinit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by the Building Official or Ills Dep-
NOTE: Permit Limit One Year (E—pt DEMOLITIONS which
ONLY T
µ•pug NOTEIt"D
uty; and fees are paid, and receipt is 6C-
-�
shall be ...led nln days; MOVED -IN BUILDINGS shell be cam•
knowledged In space provided.
1
plcled
BION UIIE ON OR AGENT DAT tl16' ED
INSPECTION
DIRECTO ON T
, /
DEPARTMENT
t�'� �I�S+meetlT '-
CITY OF
_
EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
775-2525
This 14ntrlt cuven work to be done On private property ONLY.
Any rnn.�tro rt inn ut the pnbilc domain (carbo, nl drwwike, &I Yalray..
FILE.
t,ltl rryulre eelr::ratr permi,sinn.