740362.pdfI
N HE OF WORK TO BE ONE
BUILDING
DEPARTMENT
Fae ccclpt No.
AppU.tFlU
ZOO 5—#V
NIIRMIT 740362
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PERMIT
APPLICATION
(
Inside Heavy Linea
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,
PROPOSED UeE
NAME A NAME OF BUSINESS)
ADDRESS
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PLUMBING
3
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PERMISSIBLE%
ACTUAL
PLOT PLAN (Indicate Building Setbacks, abutting street.)
HEAT e: GAS LINE
9
LOT COVERAGE
LOT COVERAGE
O
FENCE
M I [NO REBS [6.Gsi
SIGN
O
RETAINING WALL
C/'JA
PEfiTfItlSIBLE ETEIGIiT
PROPOSED HEIGHT
Z
O
may[
L`1Ty
SWIMMING POOL
TELEPiiONE NUMHh.R
ACTUAL LOT AREA
TOTAL BLDG, AREA
iG
DEMOLITION
PRE -MOVE INSPECTION
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EXCAVATION OR FILL
i
2sREQUIRED
YARDS
PROPOSED YARD-
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NA
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FRONT SIDE
REAR FRONT SIDE REAR
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formation given Is correct; and that I athe owner, or tile ou
e duly thor.
Ized agent of the owner. I agree to comply with city and state laws regu-
yADDRESS
APPLICATION APPROVAL
IMIng Construction; and In doing the work authorized thereby, no person
LEGAL LOT VARIANCE OR CONDITIONAL USE
O YES [3 NO PERMIT NUCONDITIONAL
.WN
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Tule PERMIT
This application is not n permit until
PLANNING DEPT. APPROVAL DATE:
AUTHORIZES
3
K
CITY
ONLY THE
TELEPHONE NUMBER
Shall be Completed In ninety days; MOVED•IN BUILDINGS shall be cam-
lcn0 ged in apace provided.
pleted In six months.)
STREET R/W
-IGNATUITE OWN OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
EC OA's 916 U
EXISTING STREET R/W ............FT.
DEFICIENCY THIS PROPERTY
NAME
a
COMP. PLAN ST. R/W ............T.
F............FT.
M
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REMARKS
ti
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ADDRESS
x
W
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NCITY
(CHECKED BY
TELEPHONE NUMBER
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METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
STATE LICENSD NUMBER
CITY LICENSE NUMBER
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REMARK-
Legal Description of Property (Show Below
or Attach Four Caplan)
_
TYPE CONNECTION
VERIFIED BY
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PERC. TEST
PERMIT NUMBER
W
REMARKS
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FIRE ZONE TYPE OF CONSTRUCTION STREET IMPROVED
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YES [] NO
SPECIAL INSPECTOR REQUIRED GROUP
RESIDENTIAL
GAS
❑ YES 0 NO
(OCCUPANCY
NEW
❑ LINE
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
❑ NON-RESIDENTIAL
SIGN
OF EDMONDS. LOCAL SALES TAX
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ADD
REMARKS
SHOULD BE CODED 31.04.
❑ DEMOLISH
E]REATAA.INING
Y
ALTERElORCFILL
AVATE
El (ENC z.
.......... Ft.)
REPAIR
❑ INSP.PRE
SWIM
❑ POOL
NUMBER OF STORIES
NUMBER
OF
DWELLING
UNITS
N HE OF WORK TO BE ONE
Fae ccclpt No.
i
(Valuation
Plan Check No .....................
L
0,
BUILDING
PROPOSED UeE
'
y6
P.
PLUMBING
-
U
PLOT PLAN (Indicate Building Setbacks, abutting street.)
HEAT e: GAS LINE
9
O
FENCE
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
I
EXCAVATION OR FILL
i
TOTAL AMOUNT DUE
O
I hereby acknowledge that I have read this application; that the 1n.m
formation given Is correct; and that I athe owner, or tile ou
e duly thor.
Ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL
IMIng Construction; and In doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
Tule PERMIT
This application is not n permit until
relating to Workmen's Compensation Insurance.
AUTHORIZES
elgned by the Building Official or his Dep -
NOTE: Permit Limit One Year (Except DEMOLITIONN which
ONLY THE
ut and fees aro aid, and receipt is ac -
Shall be Completed In ninety days; MOVED•IN BUILDINGS shall be cam-
lcn0 ged in apace provided.
pleted In six months.)
-IGNATUITE OWN OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
EC OA's 916 U
CITY OF
EDMONDB rI)ATE
NOTE: Applicant Subject to Plan Check Fee
This 1'emat toren work to be done un prlrpte prapertr oNlr. 775-2525 6 v� % :
Any construction on the public domain (curbs, sidewalks, driveways,
marquee., ale.) will rrqulre sepatole permission. 'TTL'
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