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TYPE OF RUCTOItI STREET IMPROVED
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BUILDING DEPARTMENT Applicant Fill
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PERM
NUMBER 750 I { C7
SPECIAL INSPECTOR REQUIRED
PERMIT APPLICATION
Inside Heavy LinedLOB
ADDRESS / 1/
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RESIDENTIAL
GA8
(] YEBNO
NAME (OR NAME OF HU INEBS)
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El NEW
El LINE
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THIS
PERMISSIBLE E
LOT COVERAGE
LOT COVEAOE
LOT
NON-RESIDENTIAL
MAILING ADDRESS
LOCAL SALES TAX
SHOULD
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PERMISSIBLE HEIGHT
PROPOSED HEIGHT
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REMARKSWALL
BE CODED 31.04.MONDS.
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❑ DEMOLISH El
CITY
TELEPHONE NUMBER
ACTUAL LOT AREA
TOTAL BLDG. AREA
Z
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7,,f- r/O 3
REPAIR ❑ PN EP. ❑ POOL
m�fAr' 1 �/.
REQUIRED YARDSPROPOSED
YARDS
NUMBER OF STORIES NUMBER OF
NAME
FRONT SIDE
REAR FRONT BIDE REAR
C./ NITS DWELLING
U
UNITS
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r
NATURE OF WORK TO BE DONE
Valunllot
Fee Recelpt No.
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ADDRESS
LEOAI. LOT VARIANCE OR CONDITIONAL USE
YES E] NO PERMIT NUMBER
Plan Check No.
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TELEPHONE NUMBER
PLANNING DEPT. APPROVAL � DATE:
PLANNING
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STREET R/W
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OPLOT
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EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
PLAN (Indicate Building setbacks, abutting streets)
HEAT k GAS LINE
NAME
COMP. PLAN ST. R/W ............FT.
............FT.
FENCE
REMARKS
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ADDRESS
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CHECKED BY
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SWIMMING POOL
F
CITY
TELEPHONE NUMBER
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EXCAVATION OR FILL
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METER SIZE
SERVICE 812E
CLEARANCE
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
TOTAL AMOUNT DUE
I herby acknowledge that I have read lhle appllcallon; that the In-
I
I
,.,motion given ie correct; and that I ons the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and slate Tawe relic.
ATTENTION
APPLICATION APPROVAL
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Legal Description of Property (Show Below or Attach Four Copies)
REMAIUCd
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relntlog to Workmen's Compensation Insurance.
AUTHORIZES
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NOTE: Pe it Limit One (Except DEMOLITIONS which
TYPE CONNECTION
llty; and fees are paid, and receipt is ac -
VERIFIED BY
.ha ba co ed In mnely da • , YED-IN BUILDINGS shall be com•
knowledged in Space provided.
plelcd In monlhe.)
O
E
S1GNA LOW ER A T) DAT HIONED
INSPECTION
DIRECTO '8 B10 RE
C
7 r
DEPARTMENT
PL••RC. TEST
-
PERMIT NUMBER
n
NOTL: Applica6l Sub' et to P(a Check
EDMOND$
DATE
775-2525
a
This Permit coven work to b4f done on private property ONLY.
REMARKS
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Any construction an the public domain (.tube, sidewalks, driveways,
nm rnurr., 01.1 will r, nu Ire eepan tr orrmissloa.
FILE
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TYPE OF RUCTOItI STREET IMPROVED
F1!rE
I
NN I 0 YES 11 NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
'
RESIDENTIAL
GA8
(] YEBNO
I F—
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El NEW
El LINE
PLAN CHECK%�IIY
THIS
SITE 15 LOCATED IN THE CITY
NON-RESIDENTIAL
El
LOCAL SALES TAX
SHOULD
1
ElADD
RETAINING
/U1_
REMARKSWALL
BE CODED 31.04.MONDS.
`
❑ DEMOLISH El
EXCAVATE FEE
/y
ALTER
T OR FILL (..........z..........Ft.)
REPAIR ❑ PN EP. ❑ POOL
m�fAr' 1 �/.
NUMBER OF STORIES NUMBER OF
C./ NITS DWELLING
U
UNITS
'-
NATURE OF WORK TO BE DONE
Valunllot
Fee Recelpt No.
Plan Check No.
1
[o
BUILDING
W PROPOSED USE
�4
PLUMBING
O
OPLOT
PLAN (Indicate Building setbacks, abutting streets)
HEAT k GAS LINE
C
FENCE
i
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
-
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I herby acknowledge that I have read lhle appllcallon; that the In-
,.,motion given ie correct; and that I ons the owner, or the duty author-
Ized agent of the owner. I agree to comply with city and slate Tawe relic.
ATTENTION
APPLICATION APPROVAL
lating constmetlon; and in doing the work authorized thereby, no person
will be employed In vlolnllon of the Labor Code of the State of Washington
THIS PERMIT
This application is not It permit until
relntlog to Workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOTE: Pe it Limit One (Except DEMOLITIONS which
ONLY TI[E
WORK NOTED
llty; and fees are paid, and receipt is ac -
_
.ha ba co ed In mnely da • , YED-IN BUILDINGS shall be com•
knowledged in Space provided.
plelcd In monlhe.)
S1GNA LOW ER A T) DAT HIONED
INSPECTION
DIRECTO '8 B10 RE
7 r
DEPARTMENT
-
CITY OF
NOTL: Applica6l Sub' et to P(a Check
EDMOND$
DATE
775-2525
This Permit coven work to b4f done on private property ONLY.
Any construction an the public domain (.tube, sidewalks, driveways,
nm rnurr., 01.1 will r, nu Ire eepan tr orrmissloa.
FILE
Y