740497.pdfBUILDING DEPARTMENT ZONE PERM
Applicant Fill R 740497 y
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PERMIT APPLICATION Inside Heavy Lines
NAME 1011 NAMEOOF BUe1NEB61
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MAILING ADORES0 SD N�%e`x �• CL NV
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CITY TELEPRONE NUMBER
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NAME
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ADDRESS /
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PERMISSIBLE %
ACTUAL
LOT. COVERAGE
LAT COVERAGE '(
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PERMIdtl178L I}E IIT
PROPOSED HEIORTt� t
ACTUACTU L LOT tvRE A
TOTAL BLDG TOTAL ULD AREA
7. CI
TELEPHONE NUMBER
REQUIRED YARDS
PROPO F.DpftDB PROPO YARDS
FRONT SIDE REAR
FRONT dLDE REAR
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LEGAL LOT VARIANCE OR CO DIXAL USE
[g YES NO PERMIT NUMBER
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STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
CITYTELEPHONE
NUMBER
NAME
q A DR d _
JL/�/9�( / �
CHECKED BY
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I SERVICE BIZ I CLEARANCE
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TELEPHONE NUMBER
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TYPE CONNECTION
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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Legal Deacriptlon of Property (Show Below ar Attach Four Copies)
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PLANNI DEPT. PrP OYAL DATE:
STREET R/W
EXISTING STREET R/W ............FT.
COMP. PLAN ST. R/W ............FT.
DEFICIENCY THIS PROPERTY
............FT.
REMARKS
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CHECKED BY
METER SIZE
I SERVICE BIZ I CLEARANCE
I CHECKED BY
REMARKS
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TYPE CONNECTION
I VERIFIED BY
PERC. TEST
PERMIT NUMBER
REMARKS
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F1TYPE OF CONSTRUCTIO STREET IMPROVED
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YES 13 NO
SPECIAL INSPECCTOR REQUIRED I
OCCUPANCYT
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NEWTHIS
RESIDENTIALAS
LINE
'PL—AN
AN CHECKEDBY
SITE IS LOCAT D IN THE CITY
1:1NON-RESIDENTIALOF
SIGN
EDMONDS. LOCAL SALES TAX
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ADD
MNG
REMARKS
SHOULD BE CODED 31.04.
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❑ DEMOLISH E]WAfy
ALTER EXCAVATE FENCE
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OR FILL (......... .x .......... Ft.)
REPAIR ❑ PN Ip MOVE ❑ SWI I
POOL
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NUMBER OF STORIES NUMBER OF
DWELLING /
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt No.
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1'I¢n Check N a .....................
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BUILDING
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ld PROPOSED USE
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PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAS LINE
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O
FENCE
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SIGN
RETAINING WALL
N
SWIMMING POOL,..
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend this application; that the In -
formation given is correct; and that I am the owner, or the duty author-
Ired agent of the owner. I agree to comply with city and elate laws Milo.
APPLICATION APPLICATION APPROVAL
Iating construction;and In doing the work authorized thereby, no person
will be employed In vlolallon o/ the Labor Code or the State of Washington
THIS PERMIT
This application is not a permit until
relnti¢s to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official Or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIEE
uty; and fees are paid, and receipt Is ac -
.hall be completed In nicety days; MOVED -IN BUILDINGS shall be com•
WORK NOTED
ltnowledged in space provided.
pletsd In six menthe.)
SLG TUBE (OWNER OR AOE )
DATE SIGN D
INSPECTION
DIRECT
BI N
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IED11[ONDS
DEPARTMENT
CITY OF
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OTE; Applicant Sablect to Plan Check Fee>
DAT
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Title Permit rovers work to be done an prlvnle property ONLY.
775-2525
Any construction on lite public domain (curbs,sidewalks, driveways,
'
nmrqu.... .lc.) will require ..P -.t. permlulen.FILE
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BUILDING DEPARTMENT
App u—t Flu
BE PERMIT
Z°"E �- II �� "UNSER
APPLICATION
InBdeIeiilBg
DPERMIT
ADDRESS
NAME
(OR NAME OF BUBINEBB) j
PEI(M1IIHBIDLE cTU!`L
RLOT
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COVE�AGE
LOT COYERAGE r -'( (7.11
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MAILING ADDREBBPE011155111LE
HEIGHT pitOPOBED HEIGHT, O
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- TELEPHONE NUMBER
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TOTAL DLDG.AREA
ACTUAL LOTlA EA 7
7
CITY
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REQUIRED YARD9 PROPOSED YARDS
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FRONT BIDE ftF.AR FRONT. BIDE REAR
NAME
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LEGAL LOT VARIANCE OR CONDITIIGNAL UBE
NUMBER
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ADDREtlB
In YES ❑ NO PERMIT
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PLANNI�'7 /D,CPT. �PY1_A DATE:
TELEPHONE NUMDEIi
K�'Inl'Y
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CITY
STREET R/W O
EXISTING STREET R/W ............FT. DEFICIENCY THIS. PROPERTY
t
NAME
MP. PLAN BT. R/W ............F'r, ............FT.
REMARKS
Cp
ADORN—
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CIiECKED BY
TELEPHO E NUMBER
1,J 1
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METER dl'LE BEttV10E SIZE'
CLEARANCE
CHECKED BY
STATE LICENBD NUMBER
-CITY LICENBD N-13.1,
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REMARKS
Legal Description of Property (fine. Below or Attach Four Coplee)_`,
LOS'/7 1'!1`;7- ✓fid n //(1' e' t'y
TYPE CONNECTION VEIRIIFIED BY
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Fl NE TYPE OF CONSTRUCTIO STREET IMPROVED
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(� YEs ❑ NO
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SPECIAL INSPECTOR REQUIRED oCCUPANCy,GROUP _
j71i.1 _-� ❑ CAS
s RESIDENTIAL LINP•.
❑ YEB [3 NO
BY IS LOCATED IN THE CITY
!
❑ NEW
I
PLAN CHECKED THIS SITE
OF EDMONED1 LOCAL SALES TAX
NON-RESIDENTIAL ❑ SIGN
%' •`
/( SHOULD BE CODED 31.04,
i
ADD RETAINING
Li WALL
REMARKS
'
DEMOLISH
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"r%C /f73-
ALTER ❑ EXCAVATE FENCE
OR FILL (......... ........... Ft.)
i
REPAIR Ej INP. SWIM
❑ POOL
!
NUMBER OF STORIES
NUM1IBE- OF r
'
`
DWELLING
(/
UNITS
NATUREOFWORK TO BE DONE
Valuation
Fee Receipt No.
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Plan Check No.....................CIO
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BUILDING /
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PROPOSED USE
PLUMBING
U
!,
PLOT PLAN (Indlcn o 1 g.e t ac abutting streets)
HEAT A GAB LINE
FENCE
I
BIG.
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
EXCAVATION OR FILL
-
i
TOTAL AMOUNT DUE
//
I hereby acknowledge that I have read thle application; that the In.
L'
formation given Is correct; and that I am the owner, or the duly author-
Ized agent of the owner- I agree to comply with city and elate Iowa ngu-
ATTENTION APPLICATION APPROVAL
lacing conetructlo.: and I. doing the work authorized thereby, no person
Willbe "played In violation of the Labor code of the state or W.ffilagton
TIM. PERMIT This application is not a permit until
relit.., to Workmen's Compensation Insurance.
AUTHORIZES signed by the Building Official Or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TILE
wo. NOTED uty; and fees are paid, and receipt is ac
.hall be completed In ninety day.; 31OVED-IN BUILDINGS shall be cons-
knowledged in space provided.
plated in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
/-
INSPECTION DIRECTOfV7 810jjj�MURr�
DEPARTMENT 1 i !•
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- Lj
s' L.
CITY OF
DATE
ED51OND3
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permitf-r. work to be done an private properly ONLY.
s, driveways,
Any construction on the ,.bile domain (curb., sidewalkiv
INSPECTOR I
Marquee., ele.) will require separate permission,
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