780075.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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PERMIT _780075J
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1 Y' O L
1 O LOT AREA SUBDIVISION NO, ft�
S ❑NO _ IYI/aP
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STING STREET R/W Coo FT.'DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W G O FT, O FT'
REMARKS
STREET
AND/OR UTILITY
WORK
R/W
PERMIT R
NE NUMBER
REQ'D.
❑ YES
No
YES
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or Attach Four
GAS
❑ NEW RESIDENTIAL LINE
❑ NON-RESIDENTIAL ❑ SIGN
® ADD F1 DEMOLISH Q WALL NING
ALTER ❑ ORCFILLTE ❑ (ENCE X—FT)
NSPMOVE 'POOL REPAIR ❑
.UMBER OF STORIES NUMBER OF ��
&VG DWELLING
UNITS
NATURE OF WORK TO BE DONE
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WIRING REO'D.
SANITARY SEWER
APPV'D BY CITY ENG.
❑ YES SNO
DYES VERIFIED
❑ NO
❑ YES PEI
11NO
SIGN AREA
ALLOWED I PROPOSED
OR CU
YARDS
FRONT
I hereby acknowledge that I have read this application; that the in-
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-
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
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
SIGNATURE (OWNER OR AGENT) DATE/SIGNED
NOTE: Applicant Subject to Plan Check Fee
This Permit coven work to be done an private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
Inorqueos, etr..) will require separate oermission.
a
REQUIRED
❑ YES
CM
ENV. REVIEW
COMPLETE I EXEMPT
PLANNING REVIEW BY
b SIDE 25 REA
ADB NO,
DATE
LOT COVERAGE
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1REA OCCUPANCY
G01 D GROUP
THIS SITE IS LOCATED IN I
OF EDMONDS. LOCAL SAI
SHOULD BE CODED 31,04,
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VALUATION
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
RETAINING
POOL
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
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FEE
00I 030
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro-
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ORIGINAL - File YELLOW - Inspector
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