750371.pdfBUILDING DEPARTMENT
ZONE NUMBER 750371
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PERMIT APPLICATION Inside Heavy Lines
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ADDRESS
NAME NAME OF BUSINESS)
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PEFta11HHIBLE AOTUA.
COVERAGE 3X E0LOT COVESiAOE
MAILING ADDRESS
PERMISSIBLE HEIGHT � ROEOaE H 6 T
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CITYTE
/PHONE NUMBER
ACTUAL LO REA OTAL BLDU. AR
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71G,-
REQUIRED YARDS PROPOSED YARDS
NAME
FRO T SIDE REAR FRONT SIDE REAR
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ADDRESS
LE6 VARIAN OR CONDITIONAL USE
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STREET K/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
EXISTING
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REMARKS
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CHECKED BY
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CITY/��T�E7LEPB//ONE
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METER SIZE SERVICE SIZE CLEARANCE
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION yERlFIED BY
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PERC. TEST PERMIT NUMBER
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REMARKS
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FIRE TYPE OF NS ION STREET IMPROVED
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YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY O OUP
RESIDENTIAL
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❑ NEW
LINE
PLAN CHECK BY THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
ADD
SHOULD BE CODED 31.04.
REMARKS
❑ E]RETAINING
DEMOLISH WALL
❑ ALTER EXCAVATE ❑ PENCE
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(f:000 t Iq-7 3 Ub--K:
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❑ OR FILL (.......... x .......... Ft.)
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REPAIR El PRE -MOVE EJ SWIM
INSP. POOL
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NUMBER OF $TORIES DWELLING
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UNITBNUMBER
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NATURE QE 1Y K To DON
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Valuation
Fee Receipt No.
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Plan Check No .....................
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SUILDINC
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PROPOSED USE
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PLUMBING
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PLAN (Indicate Building setbacks, abutting etrectff)
HEAT & GAS LINE
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FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
—
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereat acknowledge that I have read this application; that the 1n-
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formation given In correct; and that I am the owner, or the duly author -
[zed agent of the owner. I agree to comply with city and state laws reg'-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work suthorized thereby, an person
will be employed In Violet[on of the Labor Code or the State of Washington
TINS PERMIT
This application is not a permit until
relating to Workmen's Compensation Iasurnnce.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Permit limit One Year (Except DEMOLITIONS which
ONLY TILE
WORK NOTED
Uty; and fees are paid, and receipt Is ac-
shall be """led nlD days; MOVED -IN BUILDINGS shall be aom•
knowledged in apace provided.
pleted In elx oat e
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SIGNATU E ( R RA ) DATE SIGNED
INSPECTION
DEPARTMENT
Cu(y�p)R'S IG TUBE
1 7 �`7
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CITY OF
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EDMONDS
DATE
NOTE: Applicant Subject to Plan Check Fee
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775-2525
This Pemdt rovers work to be done an private property ONLY.
Any rnnelrurtl¢n on rite Pusilc dnmRln (curse, elAewnlNe, driveways.
r,•nnlrr neParul,• 1 mlenlen.
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