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PERMIT APPLICATION InBldo Ileaty Lines
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DEMOLITION
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-PLANNING DEPT. APPROVAL DATE:
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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1 hereby acknowledge that I have read this application; that the In-
CHECKED BY
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Ized agent of the owner. I agree to Comply with city and state law. regu-
ATTENTION
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lating construction; and la doing the work autborized thereby, no person
.TATE LICENSE —NUMBERI
CITY LICENSE NUMBER
Will beemployed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
,
relntmg to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep- .
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ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac
.hall be cempleled In bluely days; MOVED -IN BUILDINGS shall be com•
knowledged in space provided.
REMARKS
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Legal Description Of Property (Show Below or Attach Facer Copies)
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03-8 16NAT AE
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DEPARTMENT
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EAST 12(, aF THS '3;OVTH I?rib aF-tMIG NCR7
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TYPE CONNECTION VERIFIED BY
CITY OF
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PERC. TEST PERMIT NUMBER
775-2525
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REMARKS
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SPADIAL INSPECTOR REQUIRED OCCUPANCY ORPjB
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❑ NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
RESIDENTIAL ❑ BION
LOCAL SALES TAX
OF EDMONDSBECO.
ElADD RETAINING
REMARKS SHOULD DED 31.04.
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DEMOLISH WAIT'
0 ALTER EXCAVATE El FENCE
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OR FILL (.......... x .......... Ft.)
ID PRE - SWI
REPAIR ❑ INSP. O POOL
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NUh113ER OF STORIES I F
DWELLING
UNITS
No.
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NATURE -OF -WORK TO BE DONE 1 n _O _ I
Valuation I
Fee Receipt
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PLOT PLAN (Indicate Bulldln ect nek., abutting streets)
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FENCE
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RETAINING WALL
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SWIMMING POOL
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DEMOLITION
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PRE -MOVE INSPECTION
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EXCAVATION OR FILL
TOTAL AMOUNT DILE
1 hereby acknowledge that I have read this application; that the In-
formation given le correct; and that I am the owner, or the duty aulhmr
Ized agent of the owner. I agree to Comply with city and state law. regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and la doing the work autborized thereby, no person
Will beemployed In violation of the Labor Code of the Stale of Washington
THIS PERMIT
This application is not a permit until
,
relntmg 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 ac
.hall be cempleled In bluely days; MOVED -IN BUILDINGS shall be com•
knowledged in space provided.
eleted In six months.)
_WIGNATURE (O\VNER OR AGENT) DATE SIGNED
INSPECTION
03-8 16NAT AE
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DEPARTMENT
NATEf
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CITY OF
EDIVIONDS
NOTE: Applicant Subject to Plan Check Fee
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Thl. Permit rover. work la he don n private properly ONLY.
775-2525
Any enastructlon on the public domnln (curbs, nlden'Nke. drh'eway.,
nuvquees, ale.) x111 require separate permission.
FILE
' Legal Description of Property (Show Below or Attach Four Copies) i _ 1.J/j�
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Fee
Receipt No.
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RESIDENTIAL
USE PERMIT (:,."••. ••
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NEW
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BUILDING DEPARTMENT Applicant Fin
ONE NUMBER
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❑ NON-RESIDENTIAL
PERMIT APPLICATION
IInsida Heavy Lines
'30§
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PLUMBING
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WALL
NAME (OR NAME OF BUSINESS)
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PERMISSIBLE ACTUAL
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REPAIR
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LOT COVERAGE ypT COVESYAGE
vUlu/IER OF STORIESI NUMBER OF
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MAILING ADDRESS
UNITS
PERMISSIBLE HEIGHT HEIGHT
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT BLUE REAR
NAME1
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I SWIMMING POOL
LEGAL LOT VAR ANCE OR CONDITIONAL USE
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ADDRESS
YES❑ NO PERMIT NUMBER
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PRE-MOVE INSPECTION
PLANNING DEPT. APPItOV AL DATE:
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CITY NUMBER
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(TELEPHONE
STREET t7
EXIHTING ST STREET R/W ............FT. DEFICIENCY THIN PROPERTY
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NAME
COMP. PLAN ST. R/W ............FT. "' ......FT.
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ATTENTION
REMARKS O
,.flog e...truetion; and I. doing the work authorized thereby, no person
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ADDRESS
will be employed In violation of the Labor Code of the State of Washington
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This application is not a permit until
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CITY
TELEPHONE NUMBER
� (CHECKED BY
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Shall be completed In ninety days; MOVED -IN BUILDINGS Shall be nom-
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METER BILESERVICEBEVICE SIZE CLEARANCE CHECKED BY
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' Legal Description of Property (Show Below or Attach Four Copies) i _ 1.J/j�
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FIRE ZONE I TYPE
SPECIAL INSPECTOR
E] YES 'O NO
STREET IMPROVED
C] YES C3 NO
OF EDMONDS. LOCAL SALES TAX
NATURE OF WORK TO BE DONE ( •I r
C,r,V:V
Valuation
Fee
Receipt No.
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Plnn Check Na .....................
RESIDENTIAL
GAS
INE
NEW
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❑ NON-RESIDENTIAL
F
BION
ADD
KING
PLUMBING
DEMOLISH
❑
WALL
ALTEREJ
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ORCFILL E
❑
FENC z_ Fl )
REPAIR
❑ INSP. RE -MOV
❑
SWIM
OOL
vUlu/IER OF STORIESI NUMBER OF
DWELLING
0
UNITS
1
FIRE ZONE I TYPE
SPECIAL INSPECTOR
E] YES 'O NO
STREET IMPROVED
C] YES C3 NO
OF EDMONDS. LOCAL SALES TAX
NATURE OF WORK TO BE DONE ( •I r
Valuation
Fee
Receipt No.
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BUILDING
PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate BuildingSte tbn,C.C[0. AbuMpcitreete)
HEAT & GAB LINE
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FENCE
... .1 SIGN
RETAINING WALL
I SWIMMING POOL
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PRE-MOVE INSPECTION
'
EXCAVATION OR FILL
TOTAL AMOUNT
I hereby acknowledge that I have read this application; that In. In-
formation given Is correct; and that I am the owner, or the duly author -
(zed agent of the owner. I agree to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
,.flog e...truetion; and I. doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THUS PERMIT
This application is not a permit until
minting to Workmen's Compeneatica Insurance.
AUTHORIZES
1
signed by the Building Official or his Dep -ONLY
NOTE: Permit Limit One Year (Except DE51OLITIONS which
THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
Shall be completed In ninety days; MOVED -IN BUILDINGS Shall be nom-
knowledged in space provided.'i
pleted In SIX months.)
SIGNATURE (OWNER OR AGENT) DATE etGNED
INSPECTION
DIRECTOWS SIGNATURE
DEPARTMENT
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CITY OF
DATE - _
EDIIIOND3
NOTE: Appli"ni Sabjert to Plan Cbrrk Fre _
775-2525
This Permit covers work to be done on private property ONLY.
Any construction on live publlo domain !curbs, sidewalks, driveways, INSPECTOR
marquee., etc.) will repute separate permission.
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