740138.pdf1
BUILDING DEPARTMENT D�
Applltmt Fill ZONE TJ
PERMIT APPLICATION Enslde Heavy Idneg ,DB
ADDRESS
NAME (Olt NA E OF BUBINES
PERMISSIB
LOT COVET
A
ADDRESS
PERMISSIB
"'TTSI
RESIDENTIAL
(71T
I PHONE NUMBER
ACTUAL L T A( J OTAL LD/J}.(,(�FtEy
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SIGN
RETAININO
WALL
NCE
DEMOLISH
E
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POOL
IUMBER OF 8TOR1E9 NUMBER OF
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REQUIRED YAitDB PROPOSED YARDS
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PLUMBING
NAME � —7--'
FRONT S[DE REAR FRONT 81UE REAR
HEAT h GAS LINE
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LEGA SLOT VARIANCE OR CONDITIONAL U E
ERMIT NUMBER
SIGN
CITY
TE HONEF NUMDER
LA NO DEPT. R A DATE:
.
NAME
IV
H9TI eTREET R/6V,1"I'. D CIENCY THIS PROPERTY
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COMP. PLAN ST. R/w-TG.....�'. ..v...FT.
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DEMOLITION
REMARKS Driveway slopes not to exceed those
PRE -MOVE INSPECTION
indicated on Standard Awa No. 109
EXCAVATION OR FILL
ME.
CSY
ra
CITY
TELEPHONE NUMBER
I hereby acknowledge that I have read this application: that the In.
forma
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V
I
METER S I SERVICE SIZE I CLEAIIANCFl
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a
V
W
O
J
�V
a
NEW
RESIDENTIAL
EJOAS
LINE
ADD
ALTER
ID—- -RESIDENTIAL
❑
SIGN
RETAININO
WALL
NCE
DEMOLISH
E
REPAIR
❑ OROFILL
E] PRE.
O
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awl
POOL
IUMBER OF 8TOR1E9 NUMBER OF
DWELLING
UNITS
/
I
L1
E3 YES
[3 NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY Z111-OUP
YES [] NO
PLAN CHECRED RY THIS SITE IS LOCATED IN THE CITY
OF EDMON DS. LOCAL SALES TAX
Vnluntlon
Plan Check No ..............
PROPOSED USE
BUILDING.2���//.�D
�i
I
V L . /c/
PLUMBING
a i so
PLOT PLALNUIi-mccaateLBuimmi, setbacks, abutting street.)
HEAT h GAS LINE
FENCE
SIGN
.
RETAINING WALL
_
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have read this application: that the In.
forma
TOTAL AMOUNT DUE
5 /
am the given Is correct; and tbat I athe owner, or the duly author-
Ized agent of the owner. I agree to comply city and elate law. ergo-
autr
latlog conetsuetlon; and m dom6 the work authorlsad thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In vloletlon o[ tha Labor Code at the Stara a[ Washington
relatingto Workmen's Compensation Imuerpce.
THUS PERMIT
This application is not a permit until
NOTE: Permit Limit One Year t DEMOLITIONS
AUTHORIZER
ONLY THE
signed by the Building Official or his Dep-
which
shall b1 ecmpl -IN B
la nicety days; MOVED -IN EDmmxae share be nom.
WORK NOTED
uty; and fees are paid, and receipt is Be.
prated In elg monUla.)
o.
knowledged in space provided.
'
R (OWN O ADEN ATE SIGNED
INSPECTION
IRE S10 ATUAF
DEPARTMENT
/
jt
CITY OF
NOTE: Applicant Subject to Plan Check Fee
EDMONDS
ATE
Permit coven hark be done ou Drlvate property ONLY.
PR d-1107
/
say eonet
Any ll
ruetlow an the Dabe domain (embe, sidewalks, drlvewaya,
unlurr�, etr,l ulll rreul re eeDarwle pernUrelm.
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RECORD OF INSPECTIONS.
Date Passed
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Foundation