740550.pdfBUILDING DEPARTMENT AZ
Applicant Flt] OSNE (% NUMIIIER 740550
PERMIT APPLICATION I Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS
a1606- g 2 112A 1/F w,
CITYTELEPHONE NUMBER
EDM0N0s '77(c-;2.3 2 -
NAME
ADDRESS
JOB
ADDRESS
PItAISBIBLE me
COVERAJ
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AurUAL
LOT COVE, AGE
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PERMISSIBLE
(OPOB�ENUI
ACT�jr.00 REA
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REQUIRED YARDS
PROPOSED YARDH
FRONT HIDE REAR
FRONT NIU}: REAli
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LEGAL LOT VAR ANCE
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TELEPHONE NUMBER
PLA N N EPT. PPRO L
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EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY y0
NAME
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REMARKS
ADDI(ESe
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CITY TELEPHONE NUMBER
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CLEARANCE
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
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TYPE CONNECTION
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REMARKS
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FIRE ZO TYPE OF
CONSTRUCTION STREET IMPROVED
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0 YES �NO
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP '
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RESIDENTIAL
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YES
❑PLAN ➢Y0
El NEW
NE
CHECICE
THIS SITE IS LOCATED ED IN THE CITY
NON-RESIDENTIALJ
BION
DIVIONDS. LOCA SALES TAX
ElADD RETAINING
DEMOLISH WALL
jt% OULD BE CODED 31L
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06 1773
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SWIM
REPAIR ❑ IN P. ❑ POOL
NUA(BCR OF STORIES NUMBER OF
;
I DWELLING
LING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee RecclDt No.
Plan Check No .....................
BUILDING
5,
0�,
PROPOSED USE-
PLUMBING
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aPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
9
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
1
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I hove read this application; that the In.
T J(O b
form," given le correct; and that I am the Owner, or the duly author-
ized agent of theowner. I agree to comply with city and stale laws regLL•
ATTENTION
APPLICATION APPROVAL
lating construction; end In doing the work authorized thereby, no person
Will be employed In vlolalloo of the Labor Code of the Slate of Washington
THIN PERMIT
This application is not a permit until
relatlbg to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
ut and fees are 614, and receipt i9 QC -
yi P P
.hail be completed In ninety days; MOVED -IN BUILDINGS shall be tom-
knoWledged in space provided.
'
Pleled In six months.)
SIG TUI ;N (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
DIRY.",'T S10 U
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OCy//
CITY OF
EDMONDS
DATN
NOTE: Applicant Subject to Plan Check Fee
This Permit c Work lli be done private property ONLY.
775-2525
en11a public
Any construct,.., domain (curbs,a rtlrheNWs,
mnrpue, Me.) u911 raale separate, permission,
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TYPE CONNECTION IVL-l"ED BY
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read this application; that the In-
PERC• TEST
,_
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I
�1
6
REMARKS
Will ho employed In violation of the Labor Cade of the State of Washington
FIRE ZONE
TYPE OF CONSTRUCT107 STREET IMPROVED
AUTHORIZES
IBJ I YES "+ NO
I
ONLY TILE
WORK NOTED
shall be completed In bluely days: MOVED -IN BUILDINGS shall be com-
pleted In eta months.)
RESIDENTIAL
El
INE
NEN
/;:
NON-RESIDENTIAL
❑
O ON
ADD
NOTE: Applicant Subject to Plan Check Fee
BUILDING DEPARTMENT Applicant Fill
-C NBT
ZONE w NUMBER
N/LO�
w i%INING
TSIs Permit covers work to I% done on private property ONLY.
❑
PERMIT APPLICATION
InaldS Heavy Linea
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❑
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INSP. I/OVE
El
Pool,
9UMBER ON BT IIIEB
NAME (OR NAME OF BUSINESS)
PIAIMIJISIBLEACTUAL
COV ESiAOE
DWELLING
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LOT COVERAGES -,
LOT
UNITS
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m MAILING ADDRESS
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PEIthileSIBLE HEIGHT,
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PROPOSED HEIpHT
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TELEPHONE
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REQUIRED YAIIUd
PROPOSED YARDS
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FRONT' BIDE HEAR
FRONT BIDE REAR
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NAME
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3�,�
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Lk:OAI, LO'C VAR ANCIs OR CONDITIONAL URE/
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ADDRESS
0 YEH NO PERMIT 14Uh[HER
PLANN Nr) EPT. i'1'ItO AL
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CITY TELEPHONE NUhIDE1t
STREET F/W
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EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NAME
COMP. FLAN ST. R/W ............FT.
............FT.
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REMARKS
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ADDit SS
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CITYI
TELEPHONE NUMBER
CHECKED BY
,
of
AJETXR SIZE SERVICE SIZE CLEARANCE CHECKED BY
.F.Na4: NUMBLIt
I I
I
is,
TYPE CONNECTION IVL-l"ED BY
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read this application; that the In-
PERC• TEST
,_
r7" 7)
I
ATTENTION
6
REMARKS
Will ho employed In violation of the Labor Cade of the State of Washington
FIRE ZONE
TYPE OF CONSTRUCT107 STREET IMPROVED
AUTHORIZES
IBJ I YES "+ NO
I
ONLY TILE
WORK NOTED
shall be completed In bluely days: MOVED -IN BUILDINGS shall be com-
pleted In eta months.)
RESIDENTIAL
El
INE
NEN
/;:
NON-RESIDENTIAL
❑
O ON
ADD
NOTE: Applicant Subject to Plan Check Fee
w i%INING
TSIs Permit covers work to I% done on private property ONLY.
❑
DEMOLISH
❑
ALTER
❑
OROFILLTL
❑
FENCE
........... Fl.)
REPAIR
❑
INSP. I/OVE
El
Pool,
9UMBER ON BT IIIEB
NU11E11 ON
DWELLING
I
UNITS
—�
TYPE CONNECTION IVL-l"ED BY
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read this application; that the In-
PERC• TEST
PERMIT NUMBER ed
I
ATTENTION
6
REMARKS
Will ho employed In violation of the Labor Cade of the State of Washington
FIRE ZONE
TYPE OF CONSTRUCT107 STREET IMPROVED
AUTHORIZES
IBJ I YES "+ NO
I
SPECIAL INSPECTOR REQUIRED I 011"111-C/}Y-GRCUP
E] YES 10 NO Jf /
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES. TAX
SHOULD BE CODED 31.04.
REMARKS '
C / 773
Plan Check No .....................
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEM.LI 11).
PRE -MOVE INSPECTION
EXCAVATION OR FILL
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR%B SFG[jATUIIE
DATE
INSPECTOR
TOTAL AMOUNT DUE
I hereby acknowledge that 1 have read this application; that the In-
formation given Is correct; and that I am the owner, or the duly aulhor-
Ired agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
laling construction; and In doing the work authorlud thereby, no person
Will ho employed In violation of the Labor Cade of the State of Washington
TIDE PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: Permit limit One Year (Eaaept DE51OLITIONS which
ONLY TILE
WORK NOTED
shall be completed In bluely days: MOVED -IN BUILDINGS shall be com-
pleted In eta months.)
IIONATURE (OWNER OR AGENT) _ DATE SIGNED
INSPECTION
DEPARTMENT
/;:
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
775.2525
TSIs Permit covers work to I% done on private property ONLY.
Any construction on the Public domain (curbs, sidewalks, drivaWagra,
.torque.., etc.) will require separate permission.
APPLICATION APPROVAL
This application is not a permit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
DIRECTOR%B SFG[jATUIIE
DATE
INSPECTOR