750386.pdfi
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BUILDING DEPARTMENT
Applicant Fill
USE PERMIT 'J [� ']
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PERMIT APPLICATION
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NAME IDR NAME OF BUSINESS)
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LEGAL LO
❑ YES NO
LOT AREA
SUBDIVISION NO,
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PROPOSED YARDS
FRONT SIDE REAR
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NAME
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SIGN $EDA -'
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OTHER
REQUIREMENTS
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TELEPHONE NUMBER
PLANNING EPT. PPROVAL 9n� DATE
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NAME
STREET R/W /�
EXISTING STREET R/w�/�p0 FT. DEFICIENCY THIS PROPERTY
COMP. PLAN $T. R/W/_N (B j FT. Q FT.
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TELEPHONE NUMBER
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CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES Id
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WORK REQ .13 ❑ NO
UNDERGROUND ❑ YES
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WIRING REWD ❑ NO
TYPE CONNECTION VERIFIED BY
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U VES PERMIT
SEPTIC SYSTEM
APPVD BY CITY ENG. ❑ NO
NUMBER
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D O L
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REMARKS
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METER SIZE
SERVICE SIZE CLEARANCE
CHECKEO BY
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❑ NEW LfC7 RESIDENTIAL GAS
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LEINON-RESIDENTIAL ❑ SIGN
REMARKS
FIRE 20NE TYPE O(�F CwONST{{RUCTION ICODE
G�Q1� ULni
%
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❑ ADD
RETAINING
❑ DEMOLISH ❑ WALL
❑ ALTER XCAV ATE FENCE
FILL ❑ I—_ X_FT)
❑OF
REPAIR ❑ INSP. O POI L
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SPECIAL INSPECTOR AREA
REQUIRED
❑ YE$ NO
OCCUPANCY OCCUPANT
GROUP LOAD
PLAN CHECKED By THIS SITE IS LOCATED IN THE CITY
EDMONOS. LOCAL SALES TAX
SHOULD BE
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
_
UNITS
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(zN'7�.U1iV-4H0.J T5 6V_i1IuhL FII`L
NATURE OF WORK TO BE DONE
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VALUATION FEE
PLAN CHECK
NO.
PROPOSED USE
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p, PLOT PLAN INDICATE BUILDING SETBACKS,
K ABUTTING STREETS) BUILDING
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SIGN --_
11^V 4 -CL^" r RETAINING WALL
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SWIMMING POOL
617 16-00 _
I hereby acknowledge that I have read this application; that the In. TOTAL AMOUNT DUE 10 O (]
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formatlen 6""Is correct; and that I am the owner, or the duty author-
Ired agent of the owner. I agree to -11Y with city and state laws "fru- ATTENTION
lating canetructlon; and In doing the work authorised thereby, no person APPLICATION APPROVAL
Will be employed In violation of the Labor Cede of the Stale of Weahl iston THIS PERMIT
relating to Workaten-a Compensation Insurance. AUTHORIZES This application is not a permit until
NOTE: Permit limit One Year (Except DEMOLITIONS which ONLY THE signed by the Building Official or his Dep -
.hall be completed In ninety days; MOVED -IN BUILDINGS .hall be coin- WORK THE
uty; and fees are paid, and receipt Is aC-
pleted 1x monlha.i knowledged in space provided.
INSPECTION
SIG ATU E (OWNER O ENT) DATE SIGNED DEPARTMENT DIRECTOR IG A E
•.
CITY OF
EDMONDS DATE
OTE: Appli r Su6j cr to Plan Check Fee 775-2525
This Permit covers work to be done on private property ONLY.
Any construction on the ) public domain ieurbs, sidewalks, driveways, ORIGINAL - F,lc YELLOW - Inspector
marquees, etc.will require separate permission. PINK - 0-- COLD -A;--, .
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