780453.pdfBUILDING DEPARTMENT W5E PERMIT
Applicant Fill ZONE '� NUMBER
PERMIT APPLICATION Inside Heavy Lines
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NAME (OR NAME OF BUSINESS) ADDRESS C.(3�/,�
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NUMBER OF STO
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED ❑YES
PERMIT FOR WORK IN PUBLIC R/W OYES
UNDERGROUND WIRING REQUIRED OYES
CONNECTION TO SANITARY SEWER OYES
SEPTIC TANK PERMIT REQUIRED OYES
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
REMARKS
CHECKED BY I'V
U.15
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXE?
REMARKS
OR CU\ /,,.,,, (PLANNING REVIEW BY
ARDS� /
Iif FRONT I U S10E REAR
RESIDENTIAL GAS
LINE FIRE ZO�7NE TYP�CONSTRUCTION CO�
ElNON-RESIDENTIAL ❑ SIGN "l
❑ DEMOLISH RETAINING SPECIAL IN
❑ WALL REQUIRED
EXCAVATE
OR FILL
PRE -MOVE
INSP.
ES (NUMBER OF
DWELLING
UNITS
TO BE DONE
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'OSED USE
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ABUTTING STREETS)
11 FENCE rREMARKS
( X—�)
E SWIM
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
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
/ This Permit 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 AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 3U8.
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BUILDING
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THIS
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❑ NO
❑ NO
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ONO
ADD NO.
.OT COVERAGE
HEIGHT
OCCUPA
IAAD
D IN THE CITY
L SALES TAX
31.04.
E I VALUATION I FEE
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
AL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
o`I ,fir.
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
Iris Deputy; and fees are paid, and
receipt is acknowledged in space pro-
vided. I \
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ORIGINAL — File
PINK — Owner
YELLOW — Inspector
GOLD — Assessor