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BUILDING DEPARTMENT
AppLcant Flli
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PERMIT APPLICATION
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PLAN (Indicate Building Setbacks, abutting Biracial
NAME (Oft NAME OF BUSINESS)
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PERMISSIBLE^' ACTUAL J
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EXCAVATION OR FILL.
LOT VARIANCE. OR COC�L USE
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TOTAL AMOUNT DUE
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PL 'D A P V DAT
1 hereby acknowledge that i have read this nppllcntlon; that He In.
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CITY TELEPHONE NUMBER
form ntlon given is correct; and that I am the owner, or the duly author.
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EXISTS STREET R/W`11 • DEFICIENCY THIS PROPERTY
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COMP. PLAN ST. R/P/T.L nn "f. ..t.J....FT,
ATTENTION
APPLICATION APPROVAL
11A1Driveway slopes not to exceed those
IS
ADDREd9
indicated on Standard Dwg. No. 103
THIS PERMIT
This application is not a permit until
EY
AUTHORIZE&
CCHECKED
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TELEPHONE NUMBER
ONLY THE-�—'—
WORE NOTED
uty; and fees are paid, and receipt Is SO
tai mn, alpt I D l2( RC
knowledged In space provided.
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METER SIZE SERVICE SIZE CLEARANCE
C ED BY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER j
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REMARKS
OF
Legal De r1111On 1 Props y (Show Below or Attach Four Copies)
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CITY
EDMONDS
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TYPE CONNECTION VERIFI S\Y
ON
PERC. TEST
1 1
PER NUMBER
Tide 1'ertnit cu.'en work to be done on 116—t.property ONLY.
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FIRE ZONE TYPE OF CONSTRUCTION BTAEET IMPROVED
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SPECIAL INSPECTOR QUIRED OCCUPANCY GROUP
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RESIDENTIAL LINE
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PLAN CHECKED II THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
ADD
SIGN
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RETAINING
� SHOULD BE CODED 3LL04.
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❑ DEMOLISH
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NUMBER OFF�STORIES
NUMBER OF
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Plan
Plan Check N
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BUILDING
3e� 96
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PROPOSED USE
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PLUMBING
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ZPLOT
PLAN (Indicate Building Setbacks, abutting Biracial
HEAT & GAS LINE
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PENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL.
I
1
TOTAL AMOUNT DUE
1 hereby acknowledge that i have read this nppllcntlon; that He In.
form ntlon given is correct; and that I am the owner, or the duly author.
lied agent of the Owner. I agree to comply with city and state laws ratio.
ATTENTION
APPLICATION APPROVAL
luting construction; and In doing the work euthorlred Hereby, no Dersan
will be employed In violation of He Labor Code of the State of Wsshington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZE&
signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Esccpt DEMOLITIONS winch
ONLY THE-�—'—
WORE NOTED
uty; and fees are paid, and receipt Is SO
Shall be completed In ninety days: MOVED -IN BUILDINGS Shall be nom.
knowledged In space provided.
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plated In ala month..)
_ GNA• W (OWNER Oft NT)
DAT' SIGNED
INSPECTION
D EC eI ATU E
DEPARTMENT
OF
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CITY
EDMONDS
DATE
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NOTE: Applicant Subject to Plan Chec ee
775.2525
Tide 1'ertnit cu.'en work to be done on 116—t.property ONLY.
Any rnn.Irn.I m, Ih. pn hlic domain frnrb., .Ida walk., driveways.
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