740479.pdf�+
°NE NUMBER 740479
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BUILDING DEPARTMENT
Applicant Flu
APPUC TION
Inside xeavy L+neB
ion
PERMIT
ADDRESS ! —
NAME (Oil NAME ON BUSINESS)
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PERMISSIBLE E A AL
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MAILING ADDRESS
LOT COVERAGE LOT CDVEAOE
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PERMISSIBLE HEIGHT PROPOSED HEIGHTit
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ACTVAL LOT AREA TOTAL BLDG. AREA
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O CITY TELPHONE NUMBLR
D MO NDS -//E 6 —2-6 "Z 7
REQUIRED YARDS PROPOSED YARDS N
NAME
FRONT HIDE REAR FRONT BIDE REAR
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LEGALLOT VARIANCE OR CONDITIONAL USE'
NUMBER
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ADDRESS
YES NO PERMIT
PLANNING DEPT. APPROVAL DATE:
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CITY TELEPHONE
NUMBER
R/W
STREET O
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
NAME 1,,I . 1 /�p
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COMP. PLAN °T. R/W ............FT. ..........FT. 4
REMARKS
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ADDRESS
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CHECKED BY
CITY TELEPHONE
NUMBER
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Nx
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ME ER SIZE SERVICE SIZE CLEARANCE
CFIECKED HY
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STATE LICENSE NUa1IIER IC1TY
LICENSE NUMBER
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REMARKS +
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Legal Description of Properly (Show Below or Attach Four Copley)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER M
n
REMARKS ` to
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
YES NO
SPECIAL INSPECTOR RE pUSRED GROUP
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ISE9IDENTIAL
GAS
F] LINE
(OCCUPANCY
❑ YES [J NO
E
❑ NEW
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
NO=d-RESIDENTIAL
❑ SIGN
OF EDMONDS. LOCAL SALES TAX
BE CODED 31.04.
❑ ADD
RETAINING
SHOULD
REL'MMXA`R�K
WALL DE OLISH ❑
/,e,(_r 6 N &j&x -yl
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CTE FENCE
JS/•
ALTER
OR
FILL� (.........x..........Ft.)
❑ REPAIR ❑ PR
PMOVE ❑ SWIM
POOL
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NUMBER OF STORIES
NUMBER OF
DWELLING
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UNIT.
NATURE OFiY TO„BEI
DONE
Valuation
Fee Receipt No.
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Plan Check No.. ...................
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BUILDING
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PROPOSED USE
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PLUMBING
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PLOT PLAN (Indlcato Hulm
ng setbacks, abutting streets)
HEAT d: GAB LINE
FENCE
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SIGN
tRETAINING
WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
4
EXCAVATION OR FILL
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f
TOTAL AMOUNT DUE
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I hereby acknowledge t
at I have read this application; that the In-
C1)
form; .,ven le correct;
d that I am the owner, or the duty author-
i
lzed agent of the owner. I agree
to comply with city and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing
the work authorized thereby, no person
-
will be employed In violation at
the Labor Code of the Stale of Washington
TIUS PERMIT
This application is not a permit until
relating to Workmen'. Compeneallun
Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit limit
ne Year (Except DEMOLITIONS which
ONLY TUE
WORK NOTED
uty; and fees are paid, and receipt is ac -
shelf be completed In ninety
ays; MOVED -IN BUILDINGS shall be coin-
Itnowledged in space provided.
nicted In six months.)
IGNA TOR' (OWNE R A¢ENT)
SIGNA
DATE SIGNED
INSPECTION
IRE B10N TU
12 -7
DEPARTMENT
CITY OF
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EDMONDS
D TE
r
NOTE: App ica
It Subject to Plan Check Fee
775-2525
This Pr It c re work
to bo done on privateproperty ONLY.
Any comAructlo.1 an lite p4bit.
domain (eurbe, eldewnike, drlreways,
FILE
marquees, etc.)
r111 require separate pernllW...
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RECORD OF INSPECTIONS
Date Passed
Foundation
Plumbing (Partial)
(Rough) —
Frame
ines
Furnace & Fuel Lines—
Final
Final
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