750253.pdf4
BUILDING DEPARTMENT
Applicant Fin
USE ` PERMIT ��'.
ZONE �— / NUMBER 75025 3
`
PERMIT APPLICATION
Inside Heavy Lines
ADDRESS
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NAME (OR N ON.B INEBB) '
5�.0 y 7
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PERMISSIBLE 7. ACTUAL y
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MAI LING ADDRESS
LOT COVERAGE LOT COVEIAGE /t
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PEAA(IHHIBLE H IGI PROPOSE H
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CITY` ,
TELEPHONE NUMBER
ACTU LOT AREA TOTAL 131,170. E
TS.
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R QUIRED YARDS PROPOS Dik
ARDS
NAME
T SIDE REAR FRONT IDE REAR
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ADDRESSLEG
LOT VARIANCE OR CONDITIONAL USE
Y 8 O PERMIT NUMBER
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IN6 EPT. VA A E:
CITY NUMBER
(TELEPHONE
STREETtV
NAME
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EXISTIN TREET R/Wt40!PFT. DEFICIENCY THIS PROPERTY
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TELEPHONE NUMDER
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METER SIZE
SERVICE SIZE
CLEARANCE
STATE LICENSE NUb1SEIi
CITY LICENSE NUMBER
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Legrtl Description of Property (dhow Below or Attach Four Cople9)
REMARKS
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TYPE CONNECTION
VERIFIED BY
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PI.i{C. TEST
PERMIT NUMBER
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REMARKS
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FIRE Z TYPE OF CONSTRUCTION I STREET IMPROVED
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY pUS
NEW
RESIDENTIAL
GAS
LINE
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PLAN CHECKS DY THtS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
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ADD RETAINING
DEMOLISH WALL
SHOULD BE CODED 31.04.
REMARKS
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ALTER EXCAVATE FENCE
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NATUR F WORK TO DE DONE�/J
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Valuation
Receipt NC.
Plan Check No .....................
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BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setback., abutting streets)
HEAT & GAS LINE
7
FENCE
SIGN
RETAINING WALL
9WIMTSINO POOL
DEMOLITION
,
PRE -MOVE INSPECTION
`
EXCAVATION OR FILL
I hereby acknowledgo that I have read this application; that the in.
TOTAL AMOUNT DUE`
Do,formation
given le correct; and that I am the owner, or the duly author -
(zed agent of the owner. I agree to cpmDlY with City and into (awe reg.-
lating Construction; and In doing the work auth.rized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed In Violation of the Labor Code of the State of Washington
THIS PERMIT
This application Is not a permit until
relating to Workmen's Compensation Insurance,
AUTHORIZES
signed by the Building Official or his Dep.
NOTE: Permit Limit One Year (Except DEIIOLITIONB which
ONLY THE
llt and fees are
shall be completed In ninety days; MOVED -IN BUILDINGS shall be com-
knowledged in space provided.
pleted In six months.)
tl IGNATURE�(Ot NER OR AGENT. DATE 81GNED
INSPECTION
DIRECT, VA URE
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DEPARTMENT
CITY OF
NOTE: Applicant Suk fect to Plan Check Fee
EDMONDB
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775-2525
Sr
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This Permit work to be done
sid Property ONLY.
on . (C b.. driveways,
Any csnetrucque on etc. Public domaiequine
ecurbs, permisks,sion.
moralists, etc.) velli require separate perntUsion.
FILE
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USE PERffiIT
BUILDING DEPARTMENTAppueant Fill ZONE '0 NUMBER
C ADDRESS
11 W 1 I
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F CITY TyELEPHONE NUMBER
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JOB
PERMIT APPLICATION I Insido Heavy -cm
ADDRESS
5�CJ 7
NAME (OR NAME OF BUSINEtlB)
PL•'ItM INB1BLE ,+v
ACTUALI
t
LOT COVERAGE Is�/��
m MAILING ADDRESS ,
PERMISSIBLE BEIGHT
PERMISSIBLE
PROPOSED HEIGHT
CITY
TELEPHONE NUMB4a
'rte
ACTUAL LOT AREA
TOTAL flLD EA,
TEST PERMIT NUMBER
NAME
R QUIRED YARDS
wADDRESS
E
FR N -e SIDE REAR
FRONT— fDE REAR
, 1-
CITY
(TELEPHONE NUMBER
C ADDRESS
11 W 1 I
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F CITY TyELEPHONE NUMBER
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JOB
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ADDRESS
5�CJ 7
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PL•'ItM INB1BLE ,+v
ACTUALI
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LOT COVERAGE Is�/��
LOT COVE
PERMISSIBLE BEIGHT
PERMISSIBLE
PROPOSED HEIGHT
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RKB
ACTUAL LOT AREA
TOTAL flLD EA,
TEST PERMIT NUMBER
RKS
R QUIRED YARDS
PROPOSE ARDS
FR N -e SIDE REAR
FRONT— fDE REAR
, 1-
LEGR LOT I VAR ANCE OR CONDITIONAL USE
. s. r-, Mn PF.IIAfIT NUMBER , - _id-
PPL WNING.DEPT. PP OVAL DAT .,
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PLAN ST. R/WRKS
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R SIZE
I SERVICE SIZE
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RKB
[COMP.
CONNECTION VERIFIED BY
TEST PERMIT NUMBER
RKS
WALL((
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PPL WNING.DEPT. PP OVAL DAT .,
�.2 _
STREET74/�{V / 3
EXISTING 8TREET R/W!)..�Ll:}'T. DEFICIENCY THIS PROPERTY
PLAN ST. R/WRKS
R SIZE
I SERVICE SIZE
CLEARANCE
CHEC KED BY
RKB
[COMP.
CONNECTION VERIFIED BY
TEST PERMIT NUMBER
RKS
SPECIAL INSPECTOR REQUIREDV
IMPROVED
NO
W GAS
LINE
El
El YES UPI)
PLAN CHECKS BYN
SITE IS LOCATED IN THE CITY
vTHIS
OF EDMONDS.LOCAL SALES TAX
SIGN
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WFNI
REMARKS
SHOULD 8E CODED 31.04.RETAI
WALL((
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ALL WU �
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POOL
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UNITS
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NATURE OF WORK TO BE DONEr
Vnivatlon
ReceiPt No.
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Tina Check N .......... .........._
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1Fee
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BUILDING
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PROPOSED USE
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PLUMBING
1 + 1
JPLOT
PLAN (Intllcato Building eet((b''adco, abutting attests)
HEAT & GAS LINE
FENCE
it
SIGN
RETAINING WALL
-
6WIMMIN6 POOL
I
DEMOLITION
PRE -MOVE INSPECTION
11+�
L%CIt97r1TUP OR FILL
JJ
TOTAL AMOUNT DUE
4
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I hereby acknowledge that I have read this application; that the In-
n-formation
;
form tiongiven Is correct; and that I am the owner, or the duly author -
Ind agent of the owner. I agree to comply with city and state love. toga.
ATTENTION
APPLICATION APPROVAL
lating construction; and In doing the work authorized thereby, no person
will be employed fn vlolathm of the Labor Code of the Stale of Washington
TIUS PFRMIT
This application is not a permit until
relating to Workmen's Compensation insurance.
AUTHOIUZEB
Signed by the Building Official or his Dep
-
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE:
WORK NOTED
Uty; and foes are paid, and receipt is ac
shall be completed In ninety days; MOVED -IN BUILDINGS shall be cam-
knowledged in space provided.
j
,let ed In elx months.)
s16NATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DIRECTOR'S SIGNATURE
'
DEPARTMENT
CITY OF
EDMONDS
DATE
�
NOTE: Applicant Subject to Plan Check Fee
775-2525
This Permit curers. work to bo dans on private properly ONLY.
Any construction on the Public domain (curb., sidewalks. drh'ewaye,
INSPECTOR
msrquees, etc.) vul require scP—t- permleelon.