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B_U I L m N G DEPARTMENT
Applicant Fill
USE PER b.
ZONE NUMBER
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`RRMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS /�•
NAME (OR NAME OF BUSINESS)
LEGAL LOT
LOT AREA
BDIVISION NO.
WYFS ❑NO
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MAILING ADDRESS ,, ,,'�/ ,j'Aµ, �,�%
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TREET R/W
EXISTING STREET R/W C/j� FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W �O FT'. 0 FT.
CITY CITY
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LEPHONE NUMBER
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NAME
REMARKS -
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ADDRESS
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CITY
TELEPHONE NUMBER
STREET AND/OR UTILITY WORK
REQ'D. ❑ YES �NO
R/W PERMIT REQUIRED.
❑ YES ONO
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NAME
UNDERGROUND
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TELEPHONVNUMBER.
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NUMBER
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STATE LICENSE NUMBER
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CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
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METER SIZE BUILDING,SUPPLY SIZE
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REMARKS
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SIGN AREA. ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REA
LOT COVERAGE
NEW ❑GAS
L�f RESIDENTIAL
LJ LINE
NON-RESIDENTIAL ❑ SIGN
❑ ADD
❑ DEMOLISH ❑ RETAINING
WALL
❑ ALTER ❑ EXCAVATE ❑ FENCE X—
OR FILL
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
SPECIAL INSPECTOR AREA
REQUIRED
❑ YES ❑ NO
]OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim
REPAIR a INSP. ❑ POOL
OF EDNIONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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NUMBER OF STORIES
/
NUMBER OF
DWELLING %
UNITS /
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NATURE OF WORK TO BE DONE
LC
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PLAN CHECK
No.
VALUATION
FEE
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2
F
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PROPOSED USE
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PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
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PLUMBING
HEAT & GAS LINE
LO
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FENCE
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113
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SIGN
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RETAINING WALL
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SWIMMING POOL