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USE PERM
BUILDING DEPARTMENT I Applicant Fill NUMBER (50 45
PERMIT APPLICATION Inside Heavy Lines JOB
ADDRESS G
NAME OR NF 6
AME OHUBINE 8)
PERMIB.IBLEACTUAL
� LOT COVERAGE,/ LOT COVE AGE
MAILING ADDRESS O o Y 0
PEINIISBIBLE HEIGHT-- 1 PROPOSED HEIGHTx
O CITY ,V TELEPHONE NUMB ACTUAL, LOT ARE TOTAL HLDO. AREA
~41
i1.6 I/✓�1/ /°k' G �� q `lam 7 r � t X12 �
Q ED YARD. PROP ED YARDS
NAME f FRONT SIDE REAR FRONT SIDE REAR
N J OIC/& c ✓t/ 2lo S 1 '— Q CD l
W ADDRE 8 LEGALLOT VARIANCE OR CO IONAL USE
Iyy Ell NO RAIIT NUMBE
x P DE .APP TEI
C CITY `,/,�l(� TEL NU EFt -R/IV -
STIMEET
/AMEN d ry`' " ��� EXISTING STREET R/ (�.`MM. DEFICIENCY,fTtHIS PROPERTY bad
NAME �— COMP. PLAN ST. R/VTr.���Y.f r. 1 r..FT. W
%%✓On►�'iS �Ll
RE d.
slopes not to exceed those
O ADDRESS Y P z
t QvAo6--C�IS�S( J indicated on Standard avg. No. 103
! CHE 'E/D� BY
F CITY TELEPHONE NUMBE$,� 1 ' 1' Jl%�
o cv►ow�.f Wti �P� dOI�H IIWI /+'
o t MET SIZE SERVICE SIZE CLEARANCE ACED4
STATE LIC 8^ NUMBER I CITY LICENSE NUMSEIt
a /7' Er
REBEARX13 t
Legal Description of Property (Show Below or Attach Four Copies)
YPE CONNECTION Le yERI E gy �
F= .dAl- �
y PEI[C. TEST I PER N MHER `,
!V
G7 REMARKS sa
.Aj FIRE ZONE TYPE OF CONSTRUT N STREET IMPROVED i
j
�' �❑ NO
SPECIAL INSPECTOR UDIED I OCCUPANCY GROUP
RESIDENTIAL GAS Q YES
LINE PLAN CHECKED
NEW THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL Bich 4.H.i- SH ULD BEEDMONDS. LOCAL SALES TAX
ADD RETAINING UBSARxa SHOULD BE CODED 31.04. I
WALL _
DEMOLISH Q '
❑ ALTER ❑ ORCFILLTE ❑ FENCz..........Ft.) //// (i 'V �U J✓ .0/(/V/ �V� �GN l/10 C�-/ /, '� I
REPAIR ❑ fOVE ❑ SWIM
INSP. POO
INBP. L �7v✓-,(� Ir� D•I` �I .r%�'�CiiTIO/tJ�,f I
NUMBER OF STORIES NUMDER OF
1 DWELLING
UNITS
NATURE OF WORK TO HE DONE Vali allon Fee Receipt No.
N L` w l�d GC(1
Plan Check Na ..................... SII
,r BUILDING 3,/.
� PROPOSED USE � 5✓
PLUMBING
Q PLOT PLAN (Indicate Building setback., abutting streets) HEAT At GAS LINE 94-51—
FENCE 4-51—PENCE
A SIGN
tRETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
Asa
I
Hereby acknowledge that I he,. rend this application; that the fn- TOTAL AMOUNT DUE ��
formation given Is carred; and that I am the owner, or the duly author.
Ited.tI agent t the owner. [agree toe work
with ally and elms laws raga- ATTENTION APPLICATION APPROVAL
la[Ing canalruetlon; and In doing the work authorized thoreby, ao Deleon
will be employed In and
of the Labor Code of the State of Washington TITIN PERMIT This application la not a permit until
relating to Workmen'. Compensation laeurmce, AUTHORIZES signed is the Building I noofft
er his Dep-
ONLY THE
NOTE: Permit Limit One Year (Except BUILDINGS
hall which WORK NOTED Illy; and fees are paid, and receipt is ac-
plete be completed In .tasty dnys; MOVED -IN BUILDINGS eh¢II 6e coin- Icnowledged in space provided.
plated In elx month.,) '
SIGNAT I'E (OWNLIt O/R1 AG^ENT) DAT BIONE INSPECTION
V
yl `J DEPARTMENT RE R ON TUR1,1,/
CITY OF
EDMONDB ATE
NOTE: Applicant Subject to Plan Cbeek Fee
This Permit rule. work to be done on prR'nle property ONLY. 775-2525
Any r._trnrtlnn on Ibr I I'lle dnmaln (rarbs, .Id—.Ike, drh'mvays, y
,rµ,r., rt,.> „III ri•(ulr• r;elrnrntc iiile �lon. FILE
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