770231.pdfBUILDING DEPARTMENT
USE PERMIT
Applicant Fill
ZONE NUMBER
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PERMIT APPLICATION Inside Heavy Lines
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NAME (OR NAME OF BUST ESSJ
JOB
ADDRESS
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LEGAL LOTLOYARE
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SUBDIVISION NO.
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❑YES ONO
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STREET R/W
ITY
LEPHONE NUMBER
EXISTING STREET R/W
FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST, R/W
FT. FT.
NAME CL/1
REMARKS
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ADDRESS
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CHECKED BY
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CITY TELEPHONE NUMBER
STREET AND/OR UTILITY
WORK R/W PERMIT REQUIRED
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R EO' D,
❑ YES
❑ NO ❑ YES ❑ NO
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NAME
UNDERGROUND
WIRING REQ'D.
❑ Yrs ❑ NO
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ADDRESS
TYPE C014NECTION
❑YES VERIFIED BY
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SANITARY SEWER
❑NO
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CITY TELEPHONE NUMBER
SEPTIC SYSTEM
❑YES PERMIT NUMBER
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APPV'D BY CITY ENG,
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El NO
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STATE LICENSE NUMBER CITY LICENSE NUMBER
REMARKS
Legal Description Of Pro arty (Show Below or Attach Four Copies
METER SIZE BUILDING
SUPPLY SIZE
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REMARKS
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SIGN AREA
ENV, REVIEW ADS NO,
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ALLOWED PROPOSED COMPLETE EXEMPT
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY DATE
YARDS
LOT COVERAGE
NEW CJ GAS
RESIDENTIAL
❑
FRONT
SIDE REAR
LINE
FIRE ZONE TYPE OF
CONSTRUCTION CODE
ENTIALNON-RESID❑ SIGN
ADD ❑
4� REE`LINING
DEMOLISH
ACTOR AREA
REQUIRE
OCCUPANCY OCCUPANT
ALTER EXCAVATE FENCE
OR FILL ❑ ( X FT)
❑ YES ❑ NO
GROUP LOAD
REPAIR 1:1
PLAN CHECKED By
THIS SITE IS LOCATED IN THE CITY
INSP-MOVE ❑ Po L
TAX
SHOULDOF EDCODEDA31 04,LES
NUMBER OF STORIES NUMBER OF
R RKS
•/ DWELLING
(- UNITS
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NATURE OF WORK TO BE DONE
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PR POSED use
VALUATION FEE
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0
PLAN CHECK
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NO.
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6 PLOT PLAN INDICATE BUILDING SETBACKS,
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ABUTTING STREETS)
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BUILDING
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0
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PLUMBING
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HEAT & GAS LINE
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FENCE
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SIGN
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RETAINING WALL
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SWIMMING POOL
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I hereby acknowledge that I have read this application; that the in.
TOTAL AMOUNT DUE
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formation given is correct; and that I am the owner, or the duly author-
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ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
THIS PERMIT
This application is not a permit
•
NOTE: Permit Limit one Yedl'(Except DEMOLITIONS
AUTHORIZES
until signed by the Building Official or
and FILL
PERMITS without conditional use permit, which be
ONLY THE
his Deputy; and fees are paid, and
shall completed in 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
WORK NOTED
receipt is acknowledged in space pro -
SIP14ATRE (OWN OR AG T) DAT SIGN
INSPECTION
vided.
100
DEPARTMENT DIRECTOR'S
SIGNATURE
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CITY OF
EDMONDS DATE
NO ': Applicant Subject to Plan Chvateeck Fee
775-2525
is l"Orthio
Anyhconstruction eors work to be done on he public domain (curbs, sidewalks,ydrriveways,
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marquees, etc.) will require separate
e9 p permission.
ORIGINAL -File YELLOW -Inspector
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