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ApplicantFW
PERMIT APPLICATION
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ADDRESS
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N ME (OR NAME Olr BUSINESS)
LOT PERMISSIBLE7.AL
2-70
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MAILING ADDRESS
PERNtetlIHL£ HEIGHT HTCITY
TELEPHONE NACTUAL LOT AR
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EQUIRED A DB PROPOSED YAR B
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NAME FRONT B[D£ �R1EAR FRONT B[DE
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Y O PE MIT NUMBER
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(G1TY TELEPHONE NUMBER -
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STREET k�yyrr
EXISTING REET R/LV1.'1yo. ?'T. DEFICIENCY THIS PROPERTY
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NAME COMP. PLAN ST. R/ - &:^! T.......O...FT.
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REMARKS slopes not to exceed those
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DRESSx
indicated on Standard Dwg. No. 103
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MET�qSIZE BERM11SIZE CLEARANCE
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STATE LICENSE NUMBER CITY LICENSENUMBEK
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REMARKS <
Legal Description of Property (Show Below or Attach Four
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CTION VERIFIED BY
Z1VAZ Z4doo4TYPE CONNECTION
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//JL 4/4Gf�e 54&PER0. TEST PERMIT
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REMARKS
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aFIRE
ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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SPECIAL INSPECTORR REQUIRED OCCUPANCY GROUP
YES I /
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101GA�1 ❑ e/160 -
RESIDENTIAL LI17E PLAN CHEC ED Y
NEW THIS SITE IS LOCATED IN THE CITY
% OF EDMONDS. LOCAL SALES TAX
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NON-RESIDENTIAL ❑ Bldxr /5 �..r-'°�-� SHOULD BE CODED 31.04.
❑ ADDRETAINING MARK
❑ DEMOLTBH ❑ W7 LL
❑ ALTER EXCAVATE FENCE �W!•%.jT�l.'� %/C� L./t-3 /Y I.?
❑ OR FILL ❑ (... % ..........
PRE-1 OVE S% 1211 j /1
❑ REPAIR ❑ INSP. El'� %'lyi'� l� r�/•� S/JZ /�.�i�G'C'i%%•N
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
NATURE OF WORK TCO BE DON�E-I/
Valuation
Fee
Receipt Nn.
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Plan Check N......................
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BUILDING
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PROPOSED USE
PLUMBTN6 � 7
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a PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAB LINE
21
C
FENCE
SIGN
T RETAINING WALL I
N
SWIMMING POOL
DEMOLITION
PRE-MOVE INSPECTION
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EXCAVATION OR FILL 1
TOTAL AMOUNT DUE % S2
I hereby acknowledge cant I have road this opPllcallo
that the In- •^
formation given is correct; and that I am the owner, or lh
duly author-
to
agent of the owner. I agree to comply wit k Clly and .I
to law. reg.- ATTENTION APPLICATION APPROVAL
Inting construction; and In doing the work authorizad Cher
by, no person
will beemployed In violation of me Labor Code of the Stale
of Washington THIS PERMIT This Application Is not a perinit until
relating to workmen•. compensation Insurance.
AUTHORIZES signed by the Building Official or his Dep- '
NOTE: Permit Limit One Year (E.C.PI DEMOLITIONS
ONLY THE
wl)Ieh WORK NOTED Uty; and fees Are paid, and receipt is Be
shall be completed In ninety days; MOVED-IN BUILDINGS
shall be cam- llnowledged In space provided.
pleted W siz months.)
S ItE l0 NEIt OR E T) DAT
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SIGNED INSPECTION IRE OI B ON/tTURE
/` •,DEPARTMENT
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CITY OF r� •t_
EDDfONDB ATE
NOTE: A(r�rlic rt S)rGiect to Pfau Check
Fre ._
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Thin IYnnit a ark in bo done oa private vmMrFFr
ONLV.
Any emrslrurllou me the puUllc domain (curb.• sidewalks,
drlvewp.. LE
nulrquees, ate.) nill require separate permissla.
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FIRE ZONE
TYPEF`O NST�n; 114 E D PROVED
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BUILDING DEPARTMENT~^ Applicant Fill
ZONE' Ira Nu'�ER rx
RESIDENTIAL
CAS
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Inside Heavy Lines
PERMIT APPLICATION
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DDRESS 't
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NEW
LINE
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THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
NAME (OR NAME OF BUSINESS)
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/ %�•r!�''l1'. %//,s �)'/`�F%�'
PERhI1B81HLE
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OF EDMONDS. LOCAL SALES TAX
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El ADD
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ray
MAw3LIN6 ADDRESS
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PERh118SIDLE HEIGH _ PROPOSED HEIGHT
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DEMOLISH WAIL
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ElALTER EXCAVATE ❑ FENCE
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CITY '
TELEPHONE NUMBER
AC•rUAL LOT AREA AR
TOTAL BLDG.M'A'-/i1.
/(.� iI
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PRE-OVE SWIM
REPAIR ❑ M
INSP. ❑ POOL
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EQUIRED YA C'tU9 PROPOSED YAx 8 (.
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B DWELLING
NAME
FRONT HIDE REAR SI�DU REAR
! UNITS
/FRRONN
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ADDRESS
L OAL LOT VARI—i'& OR CONDITIONAL
` PEg MIT NUMBER
Valuation
Fee Receipt NO.
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A
YEll
CITY TELEPHONE NUMBER
LANNtNo DEPT. A�Pilo AL ) D E:
`-
i PROPOSED UBE
PLUMBING,
�G
STREET IC/
EXISTING REET R/Fl01..01r. DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN ST. R/WIrJ:��• ......L�••FT.
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAB LINE
-
REMARKS
[lriv�sa:, s Tones nit to exeecd t(u�st
'
�DxEBe
indicated on Standard D:•)a. ,@o. 10'',
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SIGN
CHECKED HY
RETAINING WALL
F
CITY TELEPHONE NUMBER
SWIMMING POOL
x
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
1
y'
PRE -MOVE INSPECTION
METER BILE
";
SERVICE SIZE
CLEARANCE
CHECKED •HY
�
1
Ile
~
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In.
' �"t•�.--'—'
REDIA 8 ly /J
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formation given le correct; and that I am the owner, or the duly author-
Legal Description of Property (Show Below or Attach Four Copies)
,
c/
/,
APPLICATION APPROVAL
and
lating conetructlon; and In doing the work authorized thershy, no person
% ,n "" (,j jf�/^•/f �' /CJOf1,f�J
TYPE CONNECTION
VERIFIED BY
This,,application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by, the Building Official or his Dep -
P C/
PERMIT 11[DER
uty; and fees are paid, and receipt is ac -
.hall be Completed In Nnety day.; MOVED -IN BUILDINGS shall be nom-
knowledged in space provided.
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71)21"
p.
SIGNATURE (OWNER OR AGENT) DATE tlIONED
INSPECTION
!RECTOR'S SIGNATURE)i
j
DEPARTMENT
! ��
i,r. ..
- '.!
B,\EMARIFB ,� ( ! f / I/I rl
ca
..)..,,4 a;'`_.-�'.•.
EDMONDS
'
FIRE ZONE
TYPEF`O NST�n; 114 E D PROVED
tr
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�—�- NO
SPECIAL INSPECTOR REQUIRED OCCUPANCYGROUP--/
RESIDENTIAL
CAS
❑
❑ S ❑
I
NEW
LINE
PLANCHEC EllBYO
THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
SIGN
❑1l,?.a.�
/'= ( L
OF EDMONDS. LOCAL SALES TAX
El ADD
RETAINING
REMARK
SHOULD BE CODED 31.04.
.,I
DEMOLISH WAIL
❑
ElALTER EXCAVATE ❑ FENCE
❑ OR FILL (.......... x .......... Ft.)
.�
PRE-OVE SWIM
REPAIR ❑ M
INSP. ❑ POOL
,. J.•' •..:•• _ i iJ % .� .i/.'i-' /.S/`-C,'"'.'� r-�/:_
i
NUMBER OF STORIES NUMBER OF
B DWELLING
! UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee Receipt NO.
)
A
Plan Check N. .....................
BUILDING
i PROPOSED UBE
PLUMBING,
�G
PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT A GAB LINE
\\� ��. _• �,
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
1
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
1 hereby acknowledge that I have read this application; that the In.
' �"t•�.--'—'
formation given le correct; and that I am the owner, or the duly author-
tzed agent of the owner. I agree to comply with city and state law. regu.
ATTENTION
APPLICATION APPROVAL
and
lating conetructlon; and In doing the work authorized thershy, no person
Will be employed In of the Labor Code of the Slate of Washington
THIS PERMIT
This,,application is not a permit until
relating to Workmen'. Compensation Insurance.
AUTHORIZES
signed by, the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY TIRE
WORK NOTED
uty; and fees are paid, and receipt is ac -
.hall be Completed In Nnety day.; MOVED -IN BUILDINGS shall be nom-
knowledged in space provided.
j
pleled In elx month.,)
_
SIGNATURE (OWNER OR AGENT) DATE tlIONED
INSPECTION
!RECTOR'S SIGNATURE)i
j
DEPARTMENT
! ��
i,r. ..
- '.!
. ..
CITY OF
..)..,,4 a;'`_.-�'.•.
EDMONDS
DATE
NOTE: Applicant Subject to Plan Cbcck FCe';'
7l
1
775-2525
This Permit earere work lu be done on private property ONLY.
Any conelrucllun on the Public domain (curb&., .ide—kn, drlreways,
marquees, etc.) will require separate permission.
INSPECTOR
Date Passed
Foundation
Plumbing (Partial) S-2-;2'--- " A)
(Rough)
Frame J.�
Furnace & Fuel Lines z2.., -3- •
Final 330 -y6
oN 146 LST �3y D -17
n c / 7
�s OA)�Q M �'WK
3U �f3Ct/E 5r/zai -r 191A.4 . $Gr�
r�2oFiLE 6� ��Q^c. PLANS
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