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FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
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RESIDENTIAL LAS INE
NEW
❑ YNO
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IOCCUPANOY
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NON-
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RETAINING
El DEMOLISH O
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BUILDING DEPARTMENT
Applicant FM
PERM
°NE NUMBER L
NUMBER OF STORIES NUMBER OF
PERMIT APPLICATION
I Inside Heavy Llneg
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UNITE
NAME (OR NAME OF BUSINESS)
ADDRESS-
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at
PERMISSIBLEt� ACTUAL (/�"
LOT COVERAGEro LOT COVErtAOE
Plan Cheek No .....................
MAILING RESe
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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PLUMBING
P,(H�ONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
O
BEAT & GAS LINE
-
REQUIRED YARDS
/ •7 � � � 3 � Q G .
4G
SIGN
NAME
RETAINING WALL
PROPOSED YARDSTICLE
FRONT SIDE RFAR FRONT S1DE REAR
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NADDRESS
SWIMMING POOL
II
PRE -MOVE INSPECTION
LEGAL LOT VARIANCE OR CONDITIONAL USE
0 YES 0 NO PERMIT NUMBER
PLANNING DEPT.
:
I hereby acknowledge that I have read this application; that the In-
formation I-
TOTAL AMOUNT DUE/�
I
APPROVAL DATE.
CITY TZ PHONE NUMBER
Ized'gent of the owner. I agree to comply with City and stale laws Mgu-
]ating coasttuetlon; and in dolog the work authorized thereby, no pare..
STREET R/W
I,
will be employed In violation of the Labor Code of the State of Washington
THIS
NAME
NAME
relating to Workmen's Compensation Iasuras00.
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NOTE: Permit Limit One Year
ONLY Tl�
signed by the Building Official or his Dep-
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y
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RCOMP. PLAN ST. R/W ............FT. ............FT.
EMARHS
.,
knowledged in space provided,
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FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROVED
0 YE8 0 NO
SPECIAL INSPECTOR REQUIRED GROUP
RESIDENTIAL LAS INE
NEW
❑ YNO
E9 []ND
IOCCUPANOY
I
LD
NON-
PLAN CRECKED DY
THIS SITE IS LOCATED IN THE CITY
BION
ADD
RETAINING
El DEMOLISH O
MwttKS
OF EDMONDS. LOCAL SALES TAX
cHOLLD BE ODD Ina
ALTER EXCAVATE FENCE
❑ OR FILL 1!�/V`
N
REPAIR PRE -MOVE
O SWIM
❑ INSP. POOL
NUMBER OF STORIES NUMBER OF
DWELLING
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UNITE
NATURE OF WORK TO BE DONE
°nlunuun Fce Receipt No,
Plan Cheek No .....................
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F
BUILDING
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PLUMBING
PL/O/T PnLAN (Intllenta Sullding eetbneke, abutting e[reele)
O
BEAT & GAS LINE
-
FENCE
/ •7 � � � 3 � Q G .
4G
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application; that the In-
formation I-
TOTAL AMOUNT DUE/�
given correct; and that I am the owner, or the duly author.
V
Ized'gent of the owner. I agree to comply with City and stale laws Mgu-
]ating coasttuetlon; and in dolog the work authorized thereby, no pare..
ATTENTION
APPLICATION APPROVAL
will be employed In violation of the Labor Code of the State of Washington
THIS
relating to Workmen's Compensation Iasuras00.
PERMIT
AUTHORIZES
This application is not a permit until
_
NOTE: Permit Limit One Year
ONLY Tl�
signed by the Building Official or his Dep-
(ESC.Pt DEMOLITIONS which
.hallplate be completed In Nnely days; DSOVED-dN HDII.DIN08 shall be com-
WORK NOTED
uty; and fees are paid, and receipt is ac-
knowledged in space provided,
SIGNATURE (OWNER OR AGENT) DATE SIGNED —
INSPECTION
LD 1
DEPARTMENT
EC •e 8! RE
l oC _
CITY OF
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NOTE: Applicant Subject to Plan
EDMON )S
DATE
Check Fee
.•
Tal- Permit coven week to De done o' Private ONLY'
PR 6•1107
�
A'y constructI a an the public domain (curbe, eldewalkkendr
marquee-, eta.) will require eenar'ta Perml.emn.
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