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UILDING DIVISIO Applicant Fill
USE _EERMIT
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PERMIT APPLICAT10)? Inside Heavy Line's
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ADDRESS
NAME JOR NAME OF BUSINESSI
LEGAL DESCRIPTION
SUBDIVISION
SHORT SUB Vo.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY
EUPHONE NUMBER
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EXISTING _541-
PROPOSED - 54! -
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DEFICIENCY OF RIGHT OF WAY
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AWDRES5
UBLIC IMPROVEMENTS REQUIRED 0
DRAINAGE IMPROVEMENTS REQUIRED
0
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TELEPHONE NUMBER
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DRAINAGE PLAN REQUIRED C1
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
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'NAME
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SEPTIC TANK PERMIT REQ-0 0 No. -
ELEVATION OF PROPERTY CORNERS
& FOOTINGS REQ-0
ADDRESS
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CITY (..,00' 7
TELEPHONE NUMBER
SEE ENGINEERING MEMO DATED
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IVXVWIPM519 NUMBER
CITY LICENSE NUMBER
CHECKED BY
Legal DeSCription of PropertV (Show Below or Attach Four Copies)
METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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SIGN ARICA
ENV. REVIEW
AOB NO.
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ALLOWED I PROPOSED
C014PLETE EXEMPT
-SHORELINE 0
10,
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW By
DATE
YARDS FRONT SIDE REA �LOT
COVERAGE
GAS
New RESIDENTIAL El LINE
FIRE ZONE
T PE OF CONSTRUCTION
CODE HEIGHT
NON-RESIDENTIAL SIGN
EIADD
El DEMOLISH RETAINING
WALL
ALTER EXCAVATE FENCE
D OR FILL El I— X—FT'
SPECIAL INSPECTOR _�AREA
REQUIRED
0 YES 0
cc CUPANCY OCCUPANT
GROUP LOAD
1
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR PRE -MOVE swim
INSP. El POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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0
NUMBER OF STORIES
NUMBER OF
DWELLING
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0
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UNITS
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NATURE OF WORK TO BE DOME
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0
0
PLAN CHECK FEE
VALUATION
FEE
PLOT PLAN
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BUILDING
0
PLUMBING
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MECHAP41CAL
FENCE
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SIGN
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Applica nt. on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold harmless
the City of Edmonds, Washington, its officials, employees. and
RETAINING WALL
SWIMMING POOL
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agents from any and all claims for damages of whatever nature,
arising directly or indirectly from the issuance of this permit. Issu-
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ance of this permit shall not be deemed to modify, waive or reduce
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T�.,requirement of any city ordinance nor limit in any way the
PUBLIC WORKS DEPARTMENT tacusT
BUILDING PERMIT REVIEW 17M
(address) �dafe)
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Street Right -of -Way Exist
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-64
Access Easements Existing AIOAlf,— REQD —
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Utility Easement Existing
Lot Per Subdivision Plat--2-9--7& Assessor map—Iere-, 5j
Site Plan Checked for Accuracy. o, k-,
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Underground Wiring Reqd-
Check Accuracy of Legal Description &7. 4
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Review by 'T S-Date
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing JA'l
sn4
Hydrant Reqd Per Fire Code Size —
Detector Check �kter Reqd
Cross Connection Inspection
Fire Department Conments
,4ater ]Meter Reqd. 4,92-
Review by. Date
Septic Tank Design Approved Date
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability r, Proi
Drawing No. 5;- File No.
Side Sewer Availability�---(,4&-,
Sanitary Sewer Connection Fee Reqd.
:3:
Review
Open Ditch Existing___& 2&_f=a, Reqd.
Culvert Reqd. ' W,�, V e--. Size
94
Catch Basin Reqd. e-;V,'5ZZ, Indicate an Site Plan
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Shoulder _&-ainage maintain cKollection on swale open runoff
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En
Manhole reqd. �Vo I,- Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by, IZ, Date
Revised: lvlO-1977
Page 2 . 0
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Street Paving Reqd.
Curb * and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd. //_0
cd Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Iuprovements
'7
Street Nam Sign Reqd. .5 /
Other Signing Reqd._A/',g IA- & 71
P, , Pre Permit Site Inspection made on
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BY: S94ER
WATER
PL4
M
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ENGINEERING
Special Requirements listed in merm to Comninity Developnnnt Department,
Building Division
BY Date
o All items filled in an Building Permit Application
BY --Date
Drawings Stanped and Notations Made
BY Date
Approved by Public Works DepartmEnt
Revised: lv 10-1977
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DATE: — A - e�n
14EMO TO: Building Division.
Community Development Department
FROM; Engineering Division
Public Works Department
SUBJECT: Q3`7&5 - -4p FL - V -
After review of the subject building permit application, we have
the following comments:
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