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BUILDING DEPARTMENT I Applicant Fill ZONE
PERMIT APPLICATION Inside Heavy Lines
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NAME (OR NAME OF BUSINESS)
VAS D(ZI >wL Eht,T
W MAILING ADDRESS
3 1300 01-yM Ple. V lea
CITY ELEF
SDmO8D S 7,
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VE NUMBER
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NAME
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ADDRESS
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U I STATE LICENSE NUMBER ICITY LICEN
ADDRESS 1500
VARIANCE OR COND. U
PROPOSED YARDS
FRONT
SIGN AREA
ALLOWED PFLO TC
REMARKS
PERMIT 76()QL
NUMBER `) I ` 6
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NO. I APV
NO. /� -A/ HEIGHT
[AbA
SIDE
❑YES ❑NO
STREET R/W
EXISTING STREET R/W
COMP. PLAN ST, R/W
L
REAR
VIRONMENT
❑ COMPLETE
Ln DATE
sop **7 /v '
FT. DEFICIENCY THIS PROPERTY
FT, FT.
CHECKED BY
80N0! iV
Legal Description of Property (Show Below or Attach Four Copies) STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
C* REQ'D. ❑ YES ❑ NO ❑ YES ❑ NO
LCU LIV S. UNDERGROUND
Z WIRING REO'D. ❑ YES ❑ NO
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F• TYPE CONNECTION ❑ YES VERIFIED BY
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SANITARY SEWER C1 NO
C
U PERMIT NUMBER
N SEPTIC SYSTEM ❑ YES
W APPVD BY CITY ENG.
❑ NO
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METER SIZE SERVICE SIZE CLEARANCE CHECKED BY
REMARKS
GAS 1A
❑ NEW RESIDENTIAL LINE FIRE ZONE ® TYPEOFCONSTR ION COD �� NON-RESIDENTIAL ® SIGN j
❑ ADD
RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
ElDEMOLISH❑ WALL REQUIRED GROUP LOAD
ALTER EXCAVATE FENCE ❑ YES ❑ NO
OR FILL ❑ ( X_FT) PLAN CHECKE BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS, LOCAL SALES TAX
REPAIR INSP, POOL SH0 LD BE CID
MAR I /
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
VALUATION FEE
PROPOSED USE
PLAN CHECK
ZO NO,
6 PLOT PLAN INDICATE BUILDING SETBACKS,
E ABUTTING STREETS) BUILDING
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E/�O WINING WALLMING POOL
I hereby .acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT
relating to Workmen's Compensation Insurance. AUTHORIZES
NOTE: Permit Limit One YeGI'(Except DEMOLITIONS and FILL ONLY THE
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED
days; MOVED -IN BUILDINGS shall be completed in six months.) INSPECTION
SIG TORE (OWNER R A NT) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject tt Plan C/reck Fee
775-2525
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
RE&VOWS SIrmNfj,TQRE
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ORIGINAL - File YELLOW - Inspector
GOLD - Assessor PINK - Owner
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