750292.pdfPERMIT APPLICATION I Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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CITY,1 TELEPHCO�NE NiUMEER
NAME
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TYPE CONNECT10N
PERMISSIBLE Q
LOT COVERAGE ' 3.5 I�
UAL
T COVERAGE
PERMISSIBLE IIEIGIrT
PROPOSED HEIORTj'
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NI 6 DE T. AP L
TELEPHONE NUMBER
ACTUAL LOTACTUAL LOT A
TOTAL BLDG. A
REQUIR D YARDS
PROPO D ARDS
I.RONT� BIDE REAR
FAONT SIDE REAR
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LE L LOT 'VARIANCE OR CO DIT O L
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TYPE CONNECT10N
VERIFIED BY
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NI 6 DE T. AP L
TELEPHONE NUMBER
CITY
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NUMBER
Plan Check No .....................
STREET R/{ fi�t{'
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EXUITIN0 BT EET R/Re:.:.. �.FT. DEFICIENCY THIS PROPERTY
REMARKS
NAME
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PLAN ST. R/YHI��..`
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MAR
REMARKS
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROV.
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ADDREBB
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Cl YES 0 NO
BEAT A GAS LINE
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SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL GA8
CITY
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TELEPHONE NUMBER
ICHEC
LINE
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THIS SITE IS LOCATED IN THE CITY
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El SIGN
RETAINING WALL
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METER SIZE SERVICE SIZE CLEARANCE
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VERIFIED BY
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PL•'RC. TEST to—CPERMIT
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NUMBER
Plan Check No .....................
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REMARKS
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PLUMBING
FIRE ZONE I TYPE OF CONSTRUCTION STREET IMPROV.
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Cl YES 0 NO
BEAT A GAS LINE
11
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
RESIDENTIAL GA8
0 YES 0 NO
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NEw
LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
NON-RESIDENTIAL
El SIGN
RETAINING WALL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED DI.p4
7'
REM 9
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NATURE OF WORK 0 BE DONE
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Valuation Fee ROecIPt Na.
3.
Plan Check No .....................
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BUILDING
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PLUMBING
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PLOT PLAN (Indicate Bulldln6 setback., nbuttln6 street.)
BEAT A GAS LINE
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ADD RETAINING
ElDEMOLISH WALL
ALTER E]EXCAVATE ® FEfICE G?
OR FILL (..._�..5..........Ft.)
REPAIR PRE-hIOVE SWIM
INSP. POOL
NUhIBER OL- STORIES I NUMBER OF
DWELLING
UNITS
REM 9
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NATURE OF WORK 0 BE DONE
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Valuation Fee ROecIPt Na.
Plan Check No .....................
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BUILDING
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�O
G PROPOSED
Vi
UBE
PLUMBING
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PLOT PLAN (Indicate Bulldln6 setback., nbuttln6 street.)
BEAT A GAS LINE
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PENCE
SIGN
RETAINING WALL
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SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
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1 hereby acknowledge that I have read this application; that the in.
TOTAL AMOUNT DUE
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formatlon given 1s correct; and that I ent the owner, or the duly author-
Ized agent of theowner. I agree to Comply with city and elate lawn regu-
ATTENTION
APPLICATION APPROVAL
latlnIf construction; and In 401.9 the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Weabington
THIS PERMIT
This application is not a permit until
relating to Workmen's Cominnsatlo. Iaeursice.
AUTHORIZES
signed by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY THE
ut and fees are aid, and receipt is ac-
P P
.hall be completed In ninety days; MOVED -IN BUILDINGS shall be com•
WORN NOTED
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]Inowledged in apace provided.
Dieted In six months.)
ONATURE (O DR OR NT) DATE SIGNED
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INSPECTION
DEPARTMENT
DIRECTOR' 8
V\
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CITY OF
�
EDbiONDB
DATE
NOTE: Applicant Subject to Plan Check Fee
Thle Permit c ren work to be dune an private property ONLY.
775-2525
Any eonetruclt0n .n the Public domnln (enrM1.s1Aenalke, drlyen'eye,
.,rnurr!• rlr.� ��III rritul rr �rpurntr Prrnd..len.
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