740215.pdfV
BUILDING DEPARTMENT Applicant Flu
ZONE _ �/� NUMBIER 740215
PERMIT APPLICATION Ingido HeaYy L►Dea
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AD A
ADDRESS q01
9 U.
NAME (OR AME OF 8UB1NE881
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PERMISSIBLE ACTUAL J
LOT COVERA O Z LOT COVERAGE
MAILING ADDRESS
' II
PERMISBIBLE HEIGHT / PROPQSED
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.01
A/ALYl Gw(4l• -
AWP
O CITY
TELEPPHONE NUMBER
ACTUAL LOT AREA. TOTAL BLDO� AREA
20
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/ S �Z
dFR'r-11IR PROPOSED YARDS
NAME
&YARDS
FRONT SIDE REAR NT SIDE REAR
�� to �S
ADDAESB
LEG .LOT VARIANCE OR CO DITIONAL USE
NO P.RMIT NUMBER
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PL A P L A;P4
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CITY
TELEPHONE NUMBER
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BT ET lV
DEFICIENCY THIS PROPERTY
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EXISTS STREET R/ti�
NAME
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COMP. PLAN eT. R/1#'(."."'.FT. ......ZI..Fr.
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rF
AEtd" Drivewaysloes not to exceed those
slopes
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C ADDRESS
indicated on Standard Dwq. No. 10e
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KED BY
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CITY
TE`LEPPHONE NUMBER
F
I
O
METER SIZE BEA SIZE CLEARANCE
CH ED BY
V
STATE LICENSE NUMBER
1
CITY LICELNJSE NUMBER
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yal
7
Legal Descrlptlan or Property (Show Below or Attach Four Copies)
REMARKS V!
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TYPE VERGED BY
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C,-::;Ey\IH-2
4 rdtt
PERU. TESTP
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NUMBER
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REMARKS
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FIRE ZONE
TYPE OCON BTR TION BTAEET IAIPR VED
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g/Y/ES ❑ NO
i
SPECIAL INSPECTOR
R$pUIRED
OCCUPANC1111P
I'
NEW
RESIDENTIAL
❑ GAS
NE
❑ YES [Q-yrOf
LANHEC 'D x THIS
I
j %
SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMOND5. LOCAL SALES TAX
ADD RETAINING
ElDEMOLISH O WAIT'
EF
EMAR
_
ALTER M EXCAVATE FENCE
El
1
OR FILL I .......... x .......... Ft.)
REPAIR ❑ PRE -MOVE 9WI
INSP. ElPOOLA1
,,,,J//qJy G✓ /!/ D.r/ .srTe" ii✓sP�crrd,rif
I
NUMBER OF STORIES NUMBER OF DWELLING
I
'
��i�ij0R UNITS
NATU E OF WORK TO BE DONE
Valunllon
Fee
Receipt Nn.
Plan Check No .....................
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BUILDING
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4 PROPOSED USE
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PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
7—
FENCE FENC£
SFGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
O'
7
I hereby aelrnowledge that I have rend this application; that the In.
/ /
/
formation glven Is correct; and that I am the Owner, or the duly author-
Ired agent of the owner. I agree to comply with city Md state laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the Work authorlxed thereby, no person
no
Will be employed In Violation of the Labor Code of the Bale of
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
Signed by the Building Official OT his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS Which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shall completed In ninety days; MOVE N BOILDINGS shall be coni-
knowledged in space provided,
pleled 1 months.)
NATUI (OWNER OR AGE
DATE IONIC
INSPECTION
D 'B et NA RE
'-
DEPARTMENT
CITY OF
EDMONDS
ATE
NOTE: Applicant Subject to Plan Check Fee
PR a-IIOI
a5' 7
This Permit 7wort to be dans on private property ONLY.
Ana' count ruction ou lhn public Jomnln (curbs, nldewNke, Jrlrnn'ayn
Fr LP
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