740456.pdfl
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ONE
NU�II` 74' 5'
'
BUILDING
DEPARTMENT Applicant Ful
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Inside Heavy Lines
PERMIT APPLICATION
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AD
ADDRESS �NAME
(OK NAME OF BUSINESMSJIAT
COVERAGE—
LINO ADDRESS
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PERMISSIBLE HEIGHT
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PRPOBED HEIGHT�i
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TOTAL IILDG. AREAitE0U1REDPROPOSED qRDS
CITY
TELEEPHONENUMHEItACTUAL
LOT AREA
NAME
FRONTSE
REAR FRONT SIDE
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ADD ES
LEGAL LOT VARIANCE OX CONDITIONAL USE
0 YES 0 NO PERMIT NUMBER
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PLANNING DEPT, APPROVAL DATE: I
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CITY
ITELEPHONE NUMBER
i1
iSTREET
R/W
PROPERTY 7
EXISTING STREET R/W .......
_... FT. DEFICIENCY THIS
NAME
COMP. PLAN 8T. R/W ............F
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REMARKS
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ADDitEBB
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CHECK D BY
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CITY
TELEPHONE NUMBER
F
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METER SIZE SERVICE e1ZE
CLEARANCE
CHECKED SY
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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REMAIIH.
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Legal Description of Property (Show Below or Attach FourrCooDlee)
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TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
REMARKS
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FIRE ZONE TYPE OF ONST/Rl/U ION STR E (PROVED
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2
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Q NO
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SPECIAL INSPECTOR CUIRED
OCCUPANCY GROUP
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® RESIDENTIAL
6A8
❑ LINE
❑ YES NO7
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NEW
PLAN CHECKED BY
THIS SITE IS LOCATED N THE CITY
NON-RESIDENTIAL
B[ON
EDMONDS. LOCAL( SALES TAX
31.Oi.
ADD
REMARKS
SHOULD BE CODED
SH
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❑RETAINING
DEMOISeH WALL
ALTER ❑ ORCFILL E ❑ FEN C Z .......... Ft.)
El REPAIR ❑ SWI
INSP. O POOL
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
NATURE O WOR TO BE DONE
Vnluntlon
F.G Receipt No.
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,an Check No.. ...................
BUILDING
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PROPOSED USE
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting etreels)
HEAT & GAS LINE
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FENCE
BION
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RETAINING WALL
--
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DISE
thereby acknowledge that I have read thle eDPllcnllon; that the in.
tho
formationm given la correct; and that I athe owner, or the duly aur•
Ized agent of the owner. I agree to comply with city and elate law. regu.
ATTENTION
APPLICATION f ROYAL
lating conetructl..; and In doing the work authorized thereby, no Person
will be employed In Violation or the Labor Code of the State Of WMhington
THIS PERMIT
This application Is n t a permit until
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reiallog to Workmen's Compe... unit Insurance.
AUTHORIZES
Signed by the Building Ofheial or his Dep.
NOTE: Permit Limit One Year (Ezcepl DEMOLITIONS which
ONr'1 TH
WORK NOTED
t L
uty; and fees are paid, d xeceipt is ac -
.hall be completed In nlaety days; nIOVED-IN BUILDINGS Shan h. wm•
llnowledged to space provided.
pleted In et. ...In,.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
D1R O 8 SIGN TUtI
I
DEPARTMENT
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Off.//
CITY OF
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DA
ATE
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NOTE: Applicant Subject to Plats Check Fee
775-2525
ThlsPenult em'rn work Is be dune on Drlyale property ONLY.
Any estutnrl Ian nn the Public nidewalke, driveway..
FIL
n orauees, rte.) x'111 reeulre. .Mural, pennlealon.