740628.pdfIp TUB C] NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
YES [] NO
PLAN CHECKED IIY THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
TOTAL AMOUNT DUE
Plan Check N. .....................
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.to Building setbacks, abutting streets)
Will be employed In Vlolnll- of the Labor Code of the State of Washington
LINE
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NON-RESIDENTIAL
BUILDING DEPARTMENT
Applicant Fill
RMIT
OONE NUMBER 740628
EXCAVATION OR FILL
DEMOLISH
PERMIT APPLICATION
Inside Heavy Lines
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JOB
ADDRESS
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DEPARTMENT
ORCFlI.AI.TE
CITY OF
NAME (OR NAME OF BUSINESS)
EDMONDS
.NOTE: Applicant Subject to Plan Check Fee
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PERAt1tlB1HLE
LOT COVERAGE LOT COVEWAGE
REPAIR
❑ INS PRE -MOVE
❑
MAILING ADDRESS`
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U\113E1] _OFSTORIES NUMBER OF
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
DWELLING
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TELEPHONE NUMBER
ACTUAL LOT AREA TOTAL BLDG. AREA
UNITS
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ftEQVIRED YARDS YROPOBED YARDS
NAME
FRONT SIDE REAR FRONT BIDE REAR
LEGAL LOT VARIANCE OR CONDITIONAL USE
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ADDRESS
0 YEB ONOPERMIT NUMBER
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CITY
TELEPHUNE NUMBER
PLANNING DEPT. APPROVAL DATE:
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STREET R/W
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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METER SIZE I SERVICE SIZE I CLEARANCE
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Ip TUB C] NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
YES [] NO
PLAN CHECKED IIY THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
TOTAL AMOUNT DUE
Plan Check N. .....................
❑
Ized alien[ of the owner, I agree to comply With city and elate )awe ragu-
NE{VREBIDENTIAL
.to Building setbacks, abutting streets)
Will be employed In Vlolnll- of the Labor Code of the State of Washington
LINE
0
ADD
NON-RESIDENTIAL
❑
SIGN
PRE -MOVE INSPECTION
EXCAVATION OR FILL
DEMOLISH
�O1�gTU (OWNER _ R Or, DATE SIGNED
RETAIMNO
WALL
ElALTER
DEPARTMENT
ORCFlI.AI.TE
CITY OF
PENCE
EDMONDS
.NOTE: Applicant Subject to Plan Check Fee
❑
x .......... Ft.)
REPAIR
❑ INS PRE -MOVE
❑
SWI
POOL
U\113E1] _OFSTORIES NUMBER OF
DWELLING
UNITS
Ip TUB C] NO
SPECIAL INSPECTOR REQUIRED I OCCUPANCY GROUP
YES [] NO
PLAN CHECKED IIY THIS SITE 15 LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
I hereby heknowledRe that I have fend this appllwtlon; that the In-
TOTAL AMOUNT DUE
Plan Check N. .....................
BUILDING
Ized alien[ of the owner, I agree to comply With city and elate )awe ragu-
PLUMBING
.to Building setbacks, abutting streets)
Will be employed In Vlolnll- of the Labor Code of the State of Washington
HEAT A GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby heknowledRe that I have fend this appllwtlon; that the In-
TOTAL AMOUNT DUE
formallon Riven iscorrect; and that I am the owner, or the duly anther.
Ized alien[ of the owner, I agree to comply With city and elate )awe ragu-
lating conetructlon; and In doing the Work authorized thereby, no person
ATTENTION
Will be employed In Vlolnll- of the Labor Code of the State of Washington
TH18 PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE: )re 1}"Lifiii} ne IBQr (Except DEMOLITIONS which
ONLY TIIE
.hall be eQmp L{Od In nln ty ye; gOVED-IN HDILDIN08 hall be was-
WORK NOTED
pletn-SIX onthe.)
�O1�gTU (OWNER _ R Or, DATE SIGNED
INSPECTION
�W ,(
DEPARTMENT
(1!-. .C.
CITY OF
EDMONDS
.NOTE: Applicant Subject to Plan Check Fee
o
This I'ermlt coven work to be done on private property ONLY.
A.3' eniinlrnrllon nn ifie 1 blic dnnmin (,.,be, eldrn'nikn, drl--ye,
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.
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