740539.pdf4
BUILDING DEPARTMENT
ZOaNE
NUMBI
ER 74b`)`;q
Applicant Flll
PERMIT APPLICATION Inside Heavy Lines
JOB
NAME NAME OF BUSINESS)
ADDRESS
v
/(OR
W / /�-"• C_���F�%� �/�-'
LOT COVERAOEs
LOT COVES�AOE
PERa11881BLE HEIGHT
PROPOSED NEIGH O
CITY�TELEPHONE
;_T1
x
ACTUAL LOT AREA TOTAL BLDG. AREA
O/Y(y
�NUMBER
/1� I�p"V
REQUIRED YARDS
PROPOtlEU YAKUH
NAME
FRONT SIDE
REAR FRONT NIUk: RFAR
1.
ADDRESS
LEGAL LOT VARIANCE•' OI{ CONDITIONAL USE
[3 YES NO PERMIT NUMBER
G
PLANNING DEPT. APPROVAL DATE;
<
CITY TEL NUMBER
I
STREET R/W
'1
EXISTING STREET R/W ............FT.
DEFICIENCY TRIS PROPERTY
asy i
NAME
COMP. PLAN ST. R/W ............FT.
............FT.
W;
_ /%C/r/ /!�•�/
ADDRESS
REMARKS
�
CITY TELEPHONE NUMBER'
CIIECKED BY
I'
z
I
O
METER SILL
111, V,CE S,7, CLEARANCE
CHECKED BY
,
STATE LICENSE NUMBER
CITY LICENSE NUMBER
M
(i1
Legal Description at Properly (Snow Below or Attach Four Copley)
IiEMAItKS
1
TYPE CONNECTIONI
VER1F{ILD UY
I
X
PLItC. TEST
PERMIT NUMBER
I
in I
j
REMARKS
O
-)
FIRE ZONE 'rYt'F OF CONNTI{UCTION STREET IMPROVED
'
I
I ;
YF.s 0 NO
HI'EC1AL INtlI'IDTGI( 1thgUI11EU OCCUPANCY GROUP
1
I
I
RESIDENTIAL
"AS
F-1
IES [] NO
I
1
NEW
NON-RESIDENTIAL
PLAN C.IECI(L. HY
THIS SITE IS LOCATED IN THE CITY
SIGN
OfEDMONDS. LOCAL SALES TAX
I
I
El ADD
RETAINING
It LAf AllKtl
SHOULD BE COD ED 3109
,
DEMOLISH WALL
❑ ALTER EXCAVATE FE(•iCE
Fence requirements - section 12.14.040
I
❑ OR FILL ®
REPAIR ❑ INSPAfOVE ❑ POGL /
attached.
NUMBER -OF STORIESI NUMBER OF
DWELLING
UNITS
NATURE OF WORK O BE DONE
t'nluntlan
Fee Receipt No.
Pince Chrrk Nn .....................
BUILDING
'
PROPOSED UBE
UU
PLUMBING
W
PLOT PLAN (Indicate Building setbacks, abutting nl reels)
HEAT A OAR LiNF:
j
FENCE
Q
-
0 —,Q
00
HIHN
t
RETAINING WALL
•
N
SWIMMING POOL
DEMOLITION
PRE•MOVFI INRPECT]GN
EXCAVATION OR FILL
1
TOTAL AMOUNT DUE
I hereby acknowledge that I have rend thin appllcallon; that the In•
tormntlen given Is correct; and (hat I alai the owner, or the duty author.
O
Iied agent r the owner. I agree to comply with Illy and stale laws arson
intlnR construction and In doing the work aulhorlard thereby, no parson'
ATTENTION
APPLICATION APPROVAL
will be employed In vlolatlon or the Labor Code of the Stall of Wmhinglon
Tills PER511T
to Workmen's Compensation Insurance,
This application is not a permit until
NOTE: Permit limit One Year (Except
ZEtl
AUTILYIORITIIE
ON
signed by the Building Official or his Dep-
j
UE1to LiTiom, whirl,
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be cam•
WORK NOTED
Uty; and fees are paid, and receipt is ac-
-
pletOd In .Ix month..)
knowledged In space provided.
SIONATURIa (OWNER Olt AGENT) DATE BI NED
INSPECTION
DEPART -ENI,
Dl OR'8 BIGNATUBE /—
�' G•c -"
CITY OF
NOTE: Applicant Subject to Plan Cbrek Fee
EDDIONDS
DATE -'
775-2525
_ � _�
,
This Permit cures work In be done an priral- property ONLY.
Any construction on Ilia Public denial. (curb., sidewalks, d rWewa7s,
rnnraurrr, rl r.l will r,•nulrr nr Pnrnlr Prrnll.slen.
FIEF,
y