Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
760650.pdf
BUILDING DEPARTMENT PERMIT APPLICATION NAMF (OR NAM/f�E/��JF BUSIINESS) / L� A i0 !r -�AJ 'E W Z 3 0 FED U F Z U J PERMIT USE UMBER Applicant Fill ZONE Inside Heavy Lines �oB A•/ ADDRESS © �� / NE 1/0 % TELEPHONE s_ 7 -/ ER CITY LICENS �d �b erty (Show Below or Attach F FRONT SIDE SIGN AREA ALLOWED PROPOSED REMARKS ❑YES ONO STREET R/W EXISTING STREET R/W COMP. PLAN ST. R/W �60650 REAR V IRON MENTAL REVIEW ❑ COMPLETE ❑ EXEMPT DEFICIENCY THIS PROPERTY FT. I CHECKED BY E NUMBER /V'/ OUf Copies) STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED REQ'D. OYES ❑NO OYES ONO UNDERGROUND WIRING REQ'D. OYES NO TYPE CONNECTION ❑ YES VERIFIED BY SANITARY SEWER ❑ NO SEPTIC SYSTEM ❑ YE PERMIT NUMBER APPVD BY CITY ENG. ❑ NO REM"KS I Z_ Z r l` GAS ❑ NEW RESIDENTIAL LINE FIR —E ZONE TYPE OF CON STR TION CODE ElNON-RESIDENTIAL ❑ SIGN /�,� ❑ ADD SPECIAL INS PECTO AREA OCCUPA`CY OCCUPANT RETAINING REQUIRED GROUP ❑ DEMOLISH ❑ WALL ❑ EXCAVATEOR FILL ❑ FENCE ❑ YES NO ALTER X_FT) PLAN CH CK BY THIS ITE IS LOCATED IN THE CITY OF E MONDS, LOCAL SALES TAX ❑❑ PRE -MOVE ❑SWIM $ U BE REPAIR INSP. POOL E`M A S /C.�C:�/ NUMBER OF ) t NUMBER OF STORIES DWELLING O( .-Q UNITS NATO E OF WORK TO BE DONE e11P/� � VA UATION FEE PROPOSED USE PLAN CHECK Z NO. _ ` 0 if P�Q O 0 y OT PLAN INDICATE BUILDING SETBACKS PL, BUILDING i ABUTTING STREETS) E U PLUMBING 0 W C -- HEAT &GAS LINE m 0 - FENCE SIGN RETAINING WALL SWIMMING POOL — I hereby acknowledge that I have read this application; that the in-1 formation given is correct; and that I am the owner, or the duly author- 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 will be employed in violation of the Labor Code of the State of Washington relating to Workmen's Compensation Insurance. NOTE: Permit Limit One Yeal'(Except DEMOLITIONS and DILL PERMITS without conditional use permit, which shall be completed in 90 days; AtOVED-IN BUILDINGS shall be completed in six months,) SIGNED SIGNATURE (O NER OR AGENT) ( NOTE: Applicant Subject to Plat Check Fee This Permit covers work to be done on private & roperty ONLY. Any construction an the ate.)public lwillrequire domain eseparate permission, driveways, ion. TOTAL AMOUNT DUE U Z_ W W z_ U Z W a W I- Q E: ATTENTION ppLICATION APPROVAL THIS PERMIT This application is not a permit until AUTHORIZES eled by the Building Official or his Dep- ONLY THE WORK NOTED uty and fees are paid, and receipt is Be" ledge d in space provided. INSPECTION DEPARTMENT r1E C SI A RE CITY OF . EDMOND. DATE 775-2525 ORIGINAL -file YELLOW - Inspector GOLD - Assessor PINK - Owner I 0