750152.pdf1
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BUILDING DEPARTMENT
PERMIT APPLICATION
I Applicant FILL
Inside Heavy Lines
UBE /1 PERMIT
ZONE // i O NUMBER 5015
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ADDRESS '71J
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LOT COVERAGE �%j LOT COV&OE
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FRONT BIDE REAR 81DF REAR
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NAME
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ADDRESS
LEGAL LOT OR CONTIONAL US !!
VARIANCE
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PLAN1411312-
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CITY
I TELEPHONE NUMBER
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STREET R/1
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
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NAME
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COMP. PLAN 8T. R/W ............FT. ......,.....FT.
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REMARKS
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ADDRE88 ' �
CHECKED BY
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TEL/EyPHONE NUMBER
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METER 812E SERVICE SIZE CLEARANCE CHECKED BY
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ST�A%T/� LI7CENSE NUMBER C1T LICENSE NUMBERI
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Legal Description of Prlepert'y"` V.lino^_w Below or Attach Four Copies)
A t\,1 DI . M yJ D D
TYPE CONNECTION
VERIFIED BY
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PEliC. TEST
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PERLUT�NUMH
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REMARKS
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FIRE ZONE TYPE OF CONS TRU ION STREET IMPROVED
SPECIAL INSPECTOR REQ
REQUIRED
OCCUPANCY GROUP
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GAB
RESSDENTIAL LINE
❑ NEW El
NON-RESIDENTIAL s3oN
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PLAN CHED THIS SITE IS LOCATED IN THE CITY
/ OF EDMONOS. LOCAL SALES TAX
.fiy ZtV SHOULD BE CODED 31.4.
I XI ADD RETAINING
ElDEMOLISH WALL
ALTER ❑ EXCAVATE ❑ FENCE
OR FILL (.......... z .......... Ft.)
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PRE- OVE SWIM
REPAIR ❑ INSP,MPOOL
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�!/.U�/ ECi/ f� L•�,f/T��/i/fj��',�//�j(/L
NUMBER OF STORIES NUM EROF
DWELLING
UNITS
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TUBE OF WORK TO BE DIANE '
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Plan Check No .....................
Valuation
Fee Recclpl No
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Pon.T' Tu 6iE10 V•k- twc im �:%A%�.
BUILDING
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ZPLUMBING
PLUMBING
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PLOT PLAN (Indicate Building setbacks, abutting streets)
HEAT & GAS LINE
FENCE
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SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
I hereby acknowledge that I have rend this application; that the In-
TOTAL AMOUNT DUE / •1 (/ C1
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tormntlon given Is correct; and that I am the owner, or the duly aulhor-
Ized agent et the owner. I agree to eomplY With Illy and elate Inwe rasa-
laiing construction; and m doing the work authorized thereby, no person
ATTENTION APPLICATION APPROVAL
Will be employed In violation of Ne Labor Code of the State of Wnnhlogtoa
relating to Workmen's Compensation Insurance.
NOTE: P rn it Limit One Year (Except DEMOLITIONS which
shall be c 1 d Inn gat nye; 3tOVED-IN BUILDINGS shall be com-
plated 1 oath¢.
THIS PERMIT This application Is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official Or his Dep -
WORK NOTED uty; and fees are paid, and receipt is so -
Imowledged In space provided.
'
S1GNA (OW t AG T) DATE BIG
INSPECTION DI C OR' BIG ATU E
DEPARTMENT CITY OF
OTE: APplicast Sub)ect to Plan Check Fce
EDDIONDS 'DATE•
775-2525 a
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This Permit r.— work la be done an private property ONLY.
Any Benet-elmu on the public domain (curbs, nldewolka, drh•ewayn.
morqueee, ale.) will require separate permission.
FII
ITS
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