750258.pdfNATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
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BUILDING
DEP A R T M E N T Applicant Fill
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PERMIT APPLICATION I Inside Heavy Lines
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BUILDING
NAME (OR NAME OF BUSINESS)
PERMISSIBLE i AC rUAL y
PROPOSED USE
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LOT COVERAGE LOT COVERAGE
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PERMISSIBLE HEIGHT PROPOSED HEIGHT
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PLOT PLAN (Indicate Building eetbaaks, abutting streets)
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TELEPHONE NUMDLR
ACTUAL LOT AREA TOTAL BLDG. AREA
CITY
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REQUIRED YARDS PROPOSED YARDS
REAR
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SIGN
FRONT BIDE REAR FRONT SIDE
NAME
RETAINING WALL
LEGAL LOT VARIANCE OIt CONDITIONAL USE
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ADDRESS
[j YES ❑ NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
CITYT LEPHONE NUMBER
DEMOLITION
STREET R/W
F.XI8TIN6 STREET R/W ............Ff, DEFICIENCY THIS PROPERTY
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NAME
COMP. PLAN ST. R/W ............FT. ............FT.
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REMARKS
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ADDIUSIM
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CHECKED BY
TOTAL AMOUNT DUE
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CITY TELEPHONE NUMBER
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SIZE SERVICE SIZE CLEARANCE CHECKED BY
OMETER
STATE LICENSE NUMBER CITY LICENSE NUMBER
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REMARKS
tied agent of too ox•ner. I agree to comply with City and elate laws regu-
ATTENTION
Legal Description Of Properly (Show Below or Attach 1•our Copies)
lating Construction; and In doing the work authorized thereby, no person
TYPE CONNECTION VERIFIED BY
will bee,,I,Y,d is violation, of the Labor Code of the Slate of Washington
THIS PERMIT
This application Is not a permit until
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rel allpg to workmen's Compensation Insurance.
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signed by the Building Official or his Dep -
PERT. TEST PERMIT NUMBER
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; find fees are paid, and receipt is Be
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knowledged In space provided.
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REMARKS
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DIA OR'S tSIONATU 'C_.,
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FIRE ZONE TYPE OF CONSTRUCTION STREET In1PRUVED
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775-2525
Thls Prrml lt r ark to be done on private properly ONLY.
SPECIAL INSPECTOR REQUIRED OCCUPANCY GROUP
Any eeastrurllonon tlin public domain (Curbs, sidewalks, drl' .Ys,
GAS
RESIDENTIAL E] LIN£
❑ YEB ❑ NO
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
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NON-RESIDENTIAL ❑ SIGN
EDMUNDS. LOCAL SALES TAX
31.04.
ADD INING
SHOULD BE CODED
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REMARKS
❑ ❑ WALL
DEMOLISH
ALTER ❑ ORFILLEXCAVATE
REPAIR ❑ PRE-SIVI
INSP. O POOL
NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS
NATURE OF WORK TO BE DONE
Valuation
Fee
Receipt No.
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Plan Check Na ....... ..... _........
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BUILDING
PROPOSED USE
PLUMBING
HEAT A GAS LINE
PLOT PLAN (Indicate Building eetbaaks, abutting streets)
FENCE
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SIGN
RETAINING WALL
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this sDPlleatfon; that the in-
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formation glven Is correct; and that I Am the owner• or the duly author -
tied agent of too ox•ner. I agree to comply with City and elate laws regu-
ATTENTION
APPLICATION APPROVAL
lating Construction; and In doing the work authorized thereby, no person
will bee,,I,Y,d is violation, of the Labor Code of the Slate of Washington
THIS PERMIT
This application Is not a permit until
rel allpg to workmen's Compensation Insurance.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
WORK NOTED
uty; find fees are paid, and receipt is Be
shall be completed In nlaety days; MOVED -IN BUILDINGS shall he cons-
knowledged In space provided.
pleted In elx month,.)
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tla TUItE ( SIGNED
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INSPECTION
DEPARTMENT
DIA OR'S tSIONATU 'C_.,
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L:Lr) LDATE
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CITY OF
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NOTE: Appli,4111 Subject !o Plan Check Fee
775-2525
Thls Prrml lt r ark to be done on private properly ONLY.
Any eeastrurllonon tlin public domain (Curbs, sidewalks, drl' .Ys,
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marquees, a c.) 11111 require separate permieslon.