740366.pdfBUILDING DEPARTMENT AppllemtFtll USS _ NUMBIEIt 740366
TOTAL AMOUNT DUE
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PERMIT APPLICATION Inside Heavy Linesr
formation given Is correct; and that I an, the owner, or the duly author -
ADDRF,SB
Cv-
ized agent of the owner. I agree to comply with city and state laws regu-
lating constmetlon; and In doing the
NAME (OR NAME OF BU8jNESS)g s —
APPLICATION APPROVAL
work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washltaton
THIS PERMIT
This application is not a permit until
relating to Workmen's cm
oDensaInsuraInsurance.tlo¢ Insurance.
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I-_ .P�1�L4 lUr.(f�i�f LOT COVERAGE LOT COYESFAOE
signed by the BuildingOfficial Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
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AILING ADDREM
PE)N118tlI8LE HEIGHT PROP08ED HEIGHT
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31GNATURE (OWNER OR AGENT)
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INSPECTION
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TELEPHONE NUMBER ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROPOSED YARDS
CITY OF-1—�
NAME FRONT SIDE REAR FRONT SIDE REAR
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NOTE: Applicant SKbjert to Plan Check Fee
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This Permit cprere work to be cone en private property ONLY.
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Any construction on the public domain (curbs, sidewalks, drlveways,
A D B LEGAL LOT VARIANCE Oft CONDITIONAL USE:
marquees, etc.l will require separate permission.
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YES ❑ NO PERMIT NUMBER
PLANNING i G DEPT. APPROVAL DATE:
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CITY TELEPHONE NUMBER
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STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
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COMP. PLAN ST. R/W ............FT. ............FT.
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'STATE LICENSE NUMBER
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SERVICE SIZE CLEARANCE
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Legal Description of Property (Show Below or Attach Four Copies)
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PERMIT NUMBE IL
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REMARKS
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SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
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RESIDENTIAL OAS ❑ YES [j No
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LINE PLAN CHECKED ➢Y THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL BION OF EDMONDS. LOCAL SALES TAX
nnn RETAINING REMARKS SHOULD BE CODED 31.04.I
WALL
DEMOLISH
ALTER ❑ FENCE jJ �� CIJ v %dd 7L� / Q'
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OR FILL (......,._x..........Ft.)
REPAIR PRE -MOVE El swim -r—
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO E DONE
Valuation
Fee Receipt No,
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BUILDING
PROPOSED USE
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PLUMBING
aPLOT
PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE
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PENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have read this application; that the In -
formation given Is correct; and that I an, the owner, or the duly author -
ized agent of the owner. I agree to comply with city and state laws regu-
lating constmetlon; and In doing the
ATTENTION
APPLICATION APPROVAL
work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washltaton
THIS PERMIT
This application is not a permit until
relating to Workmen's cm
oDensaInsuraInsurance.tlo¢ Insurance.
AUTHORIZES
signed by the BuildingOfficial Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; and fees are paid, and receipt is ac-
shelfPlete be completed In nicety days; MOVED -IN BUILDINGSshall be cam•
wledged in apace
plcted In six month:.)
provided.
31GNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
Dl OA' aiGNATUR
DEPARTMENT
7
CITY OF-1—�
EDNIONDB
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NOTE: Applicant SKbjert to Plan Check Fee
This Permit cprere work to be cone en private property ONLY.
775-2525
Any construction on the public domain (curbs, sidewalks, drlveways,
marquees, etc.l will require separate permission.
FILE
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BUILDING DEPARTMENT Fill
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AppllcaDt
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PERMIT APPLICATIOP! Inside Heavy Lines
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ADDRESS / ?1OC pl13
NAME (OR NAME OF BUSINESS) r
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PERMISSIBLE o ACTUAL J
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IAT COVERAGE LOT COVERAGE
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MAILING ADDRESS
PERDSI88IBLE I1E2611T PROPOSED HEIGHT
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CITY
TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
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REQUIRED YARDS PROPOSED YARDS
NAME
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VA ftIA NCE OR CONDITIONAL USE
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ADDRESS
C3 YES NO PERMIT NUMDER
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PLANNING DEPT. APPROVAL DATE:
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CITY
TELEPHONE NUMBER
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STREET R/W
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EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS•
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ADDRESS /
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CITY
TELEPIiONE NUMBER
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MET' 8 SERVICE
SIZE CLEARANCE
CHECKEDB Y
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-STATE LICENSE NUMBER
Y LICENSE NUMBER
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Legal Description of Property (Show Below
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REMARKS
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUAfBE iI
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REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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(
❑YES ONO
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL
❑
❑ YES 0 NO
❑ NEW
LINE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
I
❑ NON-RESIDENTIAL
OF EDMONDS. LOCAL SALES TAX
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❑ SIGN
SHOULD BE CODED 31.04.
ElADD RETAINING
❑ DEMOLISH ❑ WALL
REMARKS
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❑ ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (..........Y..........Ft')
'
REPAIRE]PRE-MOVE SWII.I
INSP. ❑ POOL
NUMBER OF STORIES NUMBER OF
DWELLING
I
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt
Noq
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rasa eneelr No .....................
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BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indlcnto .Bulldlgg->jetn eke, abutting street.)
HEAT k GAS LINE
7
FENCE
j
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
'
PRE-MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
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I hereby acknowledge that I have rend this application; that the (n-
formation given 1. correct; and that I are the owner, or the duly author-
ized ascot of the owner. I agree to comply with city and state Iowa resu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the 'work authorized thereby, no person
will be employed In violation of the Labor Code of the Slate of Washington
THIS PERMIT
This application is not a permit until
relating to Workmen's Compensation Insurance.
AUTHORIZESONLYTHE
signed by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONH which
WORK NOTED
Uty; and fees are paid, and receipt !s ac-
.hall be completed In nicety day.; MOVED-IN BUILDINGS shall be com•
11Rowledged In apace provided.
pleted In sla month..)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
I
DEPARTMENT
... .,. .., -
CITY OF
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EDIIIONDS
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NOTE: Applicant Subject to Plait Check ice
775-2525
This Pennll coven work W be done oa tnw.te property ONLY.
Any construction on the public domaln (curb., sldewaik., drWew'y.,
marquees, ate.) will require separate perml..len.
INSPECTOR