750110.pdfi
BUILDING DEPARTMENT A,pucantFm NUMeI>T 7501 i0
PERMIT APPLICATION Inside Heavy Line. JOH
ADDRESS / /y1 W O/
NAME (Oft NAME OF ESB)
PERMISSIBLE ACT
BUSUAL
r)•e LOT COVERAGE LOT COVERAGE ]{
U
BIBLE HEIGHT i
PERHEIGHT� PROPOSED HEIGHT C ,.
O b• f
OIT Y TELEPHONE NUMBER ACDU/)jt �pn ,`` TOTAL 8•}.DU�AA-E,p, / - Z •I
REQUIRED YARDS ��P tOP08 �U YARUN �
pMEFRO NST tl7IDE REAR FRONT BIDE REAR
U LEOAI. LOT VARIANCE ORCONDITIONAL USE
y�M ADDREBB XYE. 0 NO PERMIT NUMBER
V PLANNING U6')T.-APP L b
m CITY I TELEPHONE NUMBER
i
V'
p
EXISTING STn4
J' / COMP. PLAN vT. wa :''..1Ylop .-..IJ.... e W
m A DRE ADMARKB Driveway slopes not to EDI@ exceed thos Z
indicated on Standard Dw . No. 103 w
� _ 7 t cHECICEn nY
M Cl Y -/ T'}E./rLEPHONE NUMBER U�1•+L I(1 L1 JI�i1A l �t��`�� I � � � ,
VU l -22 METER SIZE I SERVICESIZECLEARANCE I CHEC D BY
BTE ICENBE NUM➢ER CITY LICENSE NUMBE (([km
�O v a 7REMAI[Ktl {
Legal Description of Froper (Sao B
elow or Attach Four Ceples)
-� S TYPE CONNECTION IVUE BY
o
PDI[C. TEST PE TUM...
m ! t
W
W ItEMARKB d I 1
7 1
I
W
FIRE Z�I TYPE OF COrRUCTIQN STREET IMPROVED
1/)T/V/r_ rte!/
YES 13 NO
T�1 ^ / SPE AL INSPECTOR REQUIRED OCCUPANCY OROU f'
i..G 1 GAB ❑ YES �NO r�
RESIDENTIAL ❑ I,]NE PLAN CHECKE DY
NEW El NON-RESIDENTIAL emrlN THE CITY
OF1 EDMONDSS SITE IS O LOCAL CATED I SALES TAX
��❑``ADD RETAINING REMARKS SHOULD BE CODED 31.04.
DEMOLISH WALL I
ALTER ❑OR
FILL
❑ FENCY.......... Ft.)
Rswim
EPAIR ❑ IN PTfOVE POOL
NUMBER OF STORIES NUMBER OF /
-/� DWELLING
��S�iyl�nrl UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No.
Plan Check No ..................... i
2 (.� BUILDING Oil
o. PROPOSED USE
PLUMBING rG6D
oPLOT PLAN (Indicate Building setbacks, abutting streets) HEAT & GAS LINE U 17 V
9 J
n FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
I
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I heresy ackoawledge that I have read this application; lila[ the In -
TOTAL AMOUNT DUE Ll
IormaUon given is
correct; And that I am the owner• or the duly author-
Ized agent of the owner. I agree to comply with city and elate Tawe regu- ATTENTION APPLICATION APPROVAL
leting conetruetloh; and I. doing the work authorized thereby, no Dcrson
will be employed In violation or the Labor Cade of the State of Washington TINS PERMIT This application is net a permit until
relating to Workmen's Compensation Insurance. AUTHORIZES signed by the Building Official or his Dep -
ONLY TILE
NOTE: ermit Limit One Year (ExceDl DE\IeLITION. which WORK NOTED Uty; and fees are paid, and receipt is ac -
shall ha o pleted In ninety days; MOVED -1N BUILDINGS shall be com• knowledged In space provided.
Dieted e t months.)
81 N 'U E (OR'NEI[ O T) DATE 1GNED INSPECTION DIRECTOR 1GN U
DEPARTMENT
CITY OF
EDAIOND9 DATFy � _ _-_
NOT plicaat SuGjcct to Plan 6",k 're 775-2525
ThinPermit corers nark to be done on private properly ONLY.
Any caaslruellsn on the public domain (eurbs, sidewalk., driveways,
marquees, etc.) will reaulre separate pertnleelen, FILE
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