740119.pdfi
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BUILDING DEPARTMENT
ZONE
PERMIT 7401 19
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PERMIT APPLICAT
ON
Inside Heavy Lines
Ion
ADDRESS
NAME (OR NAME OFOU�INEeB)
M
U
Al AD REBO
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Ph:itM1l3Btlln LE 1.
LOT COVERAGE
ACTUAL
LOT COV ESYAOE
1 %.
PERa11tltlIBLE HEIGHT
PROPOSED HEIGHT
O
O
/rte Sr -
Tgyrt3
� P� ONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
REQUIRED YARDS
PROPOSED YARDS
NAME
FRONT SIDE
REAR FRONT SIDE REAR
i
i
WADDRESS
LEGAL LOT VARIANCE
Olt CONDITIONAL USE
yH
0 YES 0 NO PERMIT NUMBER
V
C
CITY
TELEPHONE NUMBER
PLANNING DEPT. APPROVAL DATE:
!
STREET R/W
O
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NA/M
LAN BT. R/W ............FT.
............FT.
lam' GV I/�
REMARKS
1
ADDRESS
O
CHECKED BY
F
CITY
TELEPHONE NUMBER
Qj
METER 1112E
SERVICE SIZE CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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pMy�l
Lggal Description of Property (Sho{
Below or Attach Four Copies)
REMARKS
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1 i
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
�.
N
REMARXe
�
m
�
J
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a
FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES [3 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY OROUP
RESIDENTIAL
El NEW
FED
LINE
I
❑ YES NO
THIS SITE IS LOCATED IN THE CITY
1
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PLAN CHECKED BY
NON-RE6IDENTIAL
El SIGN
OF EDMONDS. LOCAL SALES TAX
ADD ❑RETAINING
DEMOLI�H
L WALL
REMARKS
SHO ILD aE CODED 3104
E] ALTER EXCAV^TE
�J(FENCE
Section 12.14.040 (fence requirements)
❑ OR FI
(.....................Ft.)
E] REPAIR PRE -MOVE
INSP.
BWitt
POOL
attached.
NUMBER OF STORIES N
MBER OF
:.
DIV
I
ELLING
U
ITB
i
NATURE OF WORK TO HE DON
Valuation
Fee Receipt No.
Plan Check No .....................
x
BUILDING
PROPOSED USE
PLUMBING
�
PLOT PLAN (Indicate Building 9emacke,
abutting elracte)
HEAT &OAS LINE
n
n
FENCE
S OGS p
oC
12
J'
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
O �7 -/ 03
TOTAL AMOUNT DUE
I hereby acknowledge that I h�'.
readO
thls that
formation given Is correct; and that
application; the In.
m
I athe owner, or the duly author-
�� /
Ize6 agent of the owner. I agree to
:empty with city and elate laws mgu•
ATTENTION
APPLICATION APPROVAL
laung construction; and In doing the
will be employed In and of the I�her
work authorized thereby, no Derean
Code of the State of Washington
THIS PERMIT
This application is not H permit until
relatlog to Workmen's Compen.atlon Insurance.
AUTHORIZES
ONLY TILE
signed by the Building Official or his Dep -
NOTE: Permit limit One Y�ar (Extep! DEMOLITIONS which
shall be completed In ninety days; OVED-IN BUILDINGS ■hall be Conn.
WORK NOTED
uty; and fees are paid, and receipt is ac -
1
Dleted In six ...the.)
lmowIedged in Space provided.
el GN TUBE (OWNERS 4R ENT
G/ (�^
.(G ( _
DATE al NED
j
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INSPECTION
DEPARTMENT
SIGNATURE
CITY OF
EDMONDS
DATE
•,:_�--
NOTE: Applicant Su lett to Plan Check Fee
This 111-11 cove" walk to 1, done on private Droperty ONLY.
Any coaslrattlm on the pebllo do{naln (,.be, s'- .elks, driveways,
pit 0-1107
marquees, ate.) wW require separate Ission.FILE