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DING DEPARTMENT Applicant Fill WOE PERMIT 780451
ZON NUMBER
MIT APPLICATION inside Heevy Lines JOB �'
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ADDRESS
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PUBLIC RIGHT OF WAY PER ORDINANCE NO,
CITY TELEPHONE NUMBER COO
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EXISTING RIGHT OF WAY
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NAME ^,^ ^ Irj PROPOSED RIGHT OF WAY
U o„1 DEFICIENCY OF RIGHT OF WAY
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F• ADDRESS STREET/UTILITY WORK REQUIRED ❑YES ENO
U PERMIT FOR WORK IN PUBLIC R/W ❑YES ONO 3
C CITY TELEPHONE NUMBER UNDERGROUND WIRING REQUIRED ❑YES RNO U_
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CONNECTION TO SANITARY SEWER El YES ENO
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NAME SEPTIC TANK PERMIT REQUIRED ❑YES IISNO 0
a: O C `Z/ SEPTIC TANK PERMIT NO,
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F CITY TELEPHONE NUMBER REMARKS
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U STATE LICENSE NUMBER CITY LICENSE NUMBER CHEC ED B
Legal Description of Property (Show Below or Attach Four Copies) MCTCFiwSr2E BUILDING SUPPLY SIZE
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RONTTYPE OOF CONSTRUCTION CODE HEIGHT
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DEMOLISH ❑RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
WALL REQUIRED �l O GROUP LOAD
❑ ALTER ORCFILLTE FENCE X—� ❑ YES O (p
PLAN CHECK D By l I I
THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS. LOCAL SALES TAX
REPAIR INSP, POOL SHOULD BE CODED 31.04,
NUMBER jOF STORIES NUMBER OF REMAr�RK�S
• DWELLING
UNITS Pw5 V R�SS INS c TIO i�'S RENlD Z
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NATURE OF WORK TO BE DONE E
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PLAN CH ECIC FEE VALUATION AFEEPROPOSED USE
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SWIMMING POOL
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE `Z 00
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 THIS PERMIT This application is not a permit
relating to Workmen's Compensation Insurance. AUTHORIZES until signed by the Building Official or
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED receipt is acknowledged in space pro -
days; MOVED -IN BUILDINGS shall be completed in six months.) vlded.
SIGN RE IO ER OR GENT) DATE SIGNED INSPECTION
��+ Q r DEPARTMENT DIRECTOR' SIGNAT R
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Lti(��LC-G� l �i %Y CITY OF F,
EDMONDS DATE
This Permit covers work to be done on private property ONLY, 775 2525
Any construction on the public domain (curbs, sidewalks, driveways, �Y
marquees, etc,) will require separate permission.
ATTENTION ORIGINAL — File YELLOW — Inspector
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINK —Owner GOLD —Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY I-IAS RFEN GRANTED. UBC 304, 306.
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