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BUILDING DEPARTMENT A U
SE PERMIT
ApplicantFill E NUMBER
PERMIT APPLICATION Inside Heavy Lines s ^ 1
NAME (OR NAME OF BUSINESS) RESS 0/1
.Robev+ � n r l C L,l DI V ISI ON NO. PLAT
ESS
V
s 7 jNEUMBTELEPH -9(zDv1 7Y.
Below Or
NE NUMBER
ASSESSOR MAP NO.
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY_ �O/ n
PROPOSED RIGHT OF WAY O/h
DEFICIENCY OF RIGHT OF WAY (:fz)
STREET/UTILITY WORK REQUIRED El YES 'BNO
PERMIT FOR WORK IN PUBLIC R/W El YES 11&NO
UNDERGROUND WIRING REQUIRED JOYES ❑NO
CONNECTION TO SANITARY SEWER El YES J/5�NO
SEPTIC TANK PERMIT REQUIRED ❑YES 14:FNO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
REMAR Kc IAA n
CHECKED BY
SUPPLY
SIGN AREA ENV REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
V/
REMARKS
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS
NEW L]r��I(' n /�\ / LOT COVERAGE
/.] RESIDENTIAL ❑ GAS OCS FRONT ((/ ` SIDE a REAR
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT
❑ ADD � NON-RESIDENTIAL SIGN 3 a !' �
DEMOLISH ❑ RWALL REQUIRED RETAINING SPECIAL INSPECTOR
OCCUPgI
SPECTOR AREA ~ OCCUPANCY J
❑ ALTER ❑ EXCAVATE FENCE ❑ YES ❑ NO GROUP LOAD
OR FILL yO
( X F"T) PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR ❑ PRE -MOVE swim OF EDMONDS. LOCAL SALES TAX
INSP, POOL SHOULD BE CODED 31,04.
UMBER OF STORIES NUMBER OF REMARKS
DWELLING
UNITS
;7TU RE OF WORK TO B D NE
lOPOSED USE PLAN CHECK FEE VALUATION
FEE
,OT PLAN INDICAIVTTEgvBUILDING SETBACKS,
ABUTTING STREETS) BUILDINGJ- t7 ECIt G30 � �+
PLUMBING
J
MECHANICAL
G (�e(6 FENCE_
111 SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read this application; that the in-
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 Year(Except DEMOLITIONS and FILL
PEY�I4S,fthout conditional use permit, which shall be completed in 90
Ja y���1 D-IN BUILDINGS shall be completed in six months
)
qSI A (OW!R O AGENT) DATE SIGNED
I rus rarmlt covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE_ nNn APPROVAL OR
A CFR'I IFIrA I r)4 nor-1.MA nlnv u_n_c nr A., r
AL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
147
APPLICATION APPROVAL
This application is not a permit
Until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro.
vided.
DIRECTOR'S SIGNATURE`
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ORIGINAL — File YELLOW — Inspector
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