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CITY LICENSE N EA
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REMARKS
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Legal Deserlpllon of Property (Show Below or Attach Four Copies)
o.PIE NUMBER 7503:0
YPE CONNECTION
VERIFIED BY
BUILDING DEPARTMENT Applicant FID
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PERMIT APPLICATION Inside Heavy Lines
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PERC. TEST
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NAME (OR NAME OF BUSINESS)
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PERMISSIBLE q
DO"A LP LOT COVERAGE LOT COVERAGE
N MAILING ADDRESS 1.04
PERMISSIBLE HEIGHT PROPOSED HEIGHT
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CITYTEL,ECP/HONENUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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'FIREZONE TYPE OF CONSTRUCTION STREET IMPROVED
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_X ✓ / REQUIRED YARDS PROPOSED YARDS
� YES � NO
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SPECIAL INSPECTOR REQUIRED GROUP
NAME FRONT SIDE REAR FRONT 81DE REAR
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LEGAL LOTVARIANCE OR CONDITIONAL USE
(] YES NO
(OCCUPANCY
THIS SITE IS LOCATED IN THE CITY
EDMONDS. LOCAL SALES TAX
ADDRESS YES NO PERMIT NUMBER
PLAN CHE xE BY
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HOULD BE CODED 31.04.
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PLANNI PT. ,P V DATE:
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CITY I TELEPHONE NUMBER
STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
❑ OR FILL (.....................Ft.)
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ADDRESS
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UNITS
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NATURE OF WORK TO HE DONE
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Fee
Receipt No.
Cil TELEPHONE NUMBER
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Plan Check No._
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tit Vv✓I/y M -TER SIZE SERVICE SIZE CLEARANCE COCKED BY
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CITY LICENSE N EA
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REMARKS
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Legal Deserlpllon of Property (Show Below or Attach Four Copies)
YPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT IIIUMIIEIVa.
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REMARKS
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'FIREZONE TYPE OF CONSTRUCTION STREET IMPROVED
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� YES � NO
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SPECIAL INSPECTOR REQUIRED GROUP
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RESIDENTIAL LIN
NEW LINE
(] YES NO
(OCCUPANCY
THIS SITE IS LOCATED IN THE CITY
EDMONDS. LOCAL SALES TAX
PLAN CHE xE BY
NON•REBIDENTIAL SIGN
HOULD BE CODED 31.04.
SH
ADO RETAINING
AR
El DEMOLISH L1 WALT
ALTER EXCAVATE El FENCE
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❑ OR FILL (.....................Ft.)
REPAIR ❑PRE -MOVE O SWIM
INSPPOOL
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NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
NATURE OF WORK TO HE DONE
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Fee
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Plan Check No._
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BUILDING
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4 PROPOSED USE
PLUMBING
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a PLOT PLAN (Indlcnto Dulidin6 ectb¢cke, abutting streets)
HEAT &CAB LINE
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FENCE
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SIGN
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RETAINING WALL
8WlMMIN6 POOL
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
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TOTAL AMOUNT DUE
I hereat' neknowiedge that I have rend this apDllcbtlan; lbat the in-
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formation given Is Correct; and that I nm the owner, or the duly bullion-
Ized agent of the owner. I agree to comply with city and elate laws reau-
ATTENTION
APPLICATION APPROVAL
inting Construction; and In doing the work authorl:ed thereby, no per.an
will be employed in violation of Ne Labor Code of the State of Washington
TIUR PERMIT
This fe not permit until
relating to Workmen's Compensation Insurance,
AUTHORIZES
the Building i
signed by the Building OPflelal or his Dep-
NOTE: Permit Limit One Year (Except DEMOL1TION8 whlrh
ONLY TIIE
WORK NOTED
Uty; and fees are paid, and receipt Is ac -
shall be completed In nlnaty day.; afOVED-IN BUILDINGS shall be cam-
knowledged in space provided.
pkted In el. months.)
SIGN URE I tYNER OR AGE')
DATE SIGNED
INSPECTION
IRE O 8 LONA URE
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DEPARTMENT
CITY OF
EDMONDB
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NOTE: Applicant Subject to Plan Check Fee
775.2525
lk to be done on private property ONLY.
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