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780604.pdfBUILDING DEPARTMENT Applicant Fill USE PERMIT PERMIT APPLICATION Inside Heavy Lines ZONE ` (Z NUMBER JOB 060 784 / / I j U NAME (OR N E OF BUSINESS) ADDRESS V 3 eL /,• r LEGAL LOT PLAT NAME U &UBDIVISION NO. W MAI ING A DRESS / YES ❑NO 3 �t Lea 0 CI '- PUBLIC RIGHT OF WAY PER ORDINANCE NO. TELEPHONE NUMBER EXISTING RIGHT OF WAY u, d r NA E PROPOSED RIGHT OF WAY I-' U DEFICIENCY OF RIGHT OF WAY 0 W ADDRE t F STREET/UTILITY WORK REQUIRED El YES El NO E U PERMIT FOR WORK IN PUBLIC R/W ❑YES ❑NO 0 E CITY TELEPHONE NUMBER UNDERGROUND WIRING REQUIRED ❑YES ONO _U Q CONNECTION TO SANITARY SEWER ❑YES El NO 0 NAMEr, SEPTIC TANK PERMIT REQUIRED El YES El NO a SEPTIC TANK PERMIT NO. 0 ADDRESS F U SEE MEMO DATED Q E CITY TELEPHONE NUMBER REMARKS F Z 0 UrWT `ELICENSE NUMBER CITY LICENSE NUMBER CHECKED BY Legal Description of Property (Show Below or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE O/ �. E W REMARKS Q 0 Z s,° 6 3 �_ SIGN AREA ENV. REVIEW ADS NO. E ALLOWED PROPOSED COMPLETE EXEMPT U SHORELINE ►�Irz J WREMARKS J , S5r&Cr,. Pkb / Ail` FAP,,+ VARIANCE OR CU PLANNING REVIEW BY DATE YARDS LOT COVERAGE NEWGAS �i I FRONT 'Air SIDE � REAR V K RESIDENTIAL ❑LIN L'YCI LINE FIRE ZONE TYPEE...•�y�OF^CONSTRUCTION CODE HEIGHT NON-RESIDENTIAL SIGN / ADD iC17CJ 1_, i45I PAM ❑ ❑ DEMOLISH "�J I ❑ RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT WALL REQUIRED GROUP LOAD ❑ ALTER EXCAVATE FENCE ❑ YES L7 NO 2O - I 7 OR FILL ( X_F-) PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY ElPRE -MOVE SWIM OF EDMONDS, LOCAL SALES TAX REPAIR INSP, O POOL SHOULD BE CODED 31.04. NUMBER OF STORIES NUMBER OF REMARKS O , e n DWELLING b 1� �� I� Z F. L[/%'(_ ^C�, UNITS W a NATURE Of WORK TO BE DONE � E F In W Q 0 � W 0 J 0 PLAN CHECK FEE 0 PROPOSE USE VALUATION FEE F Z W PLOT PLAN (INDICAffE BUILDING SETBACKS, ABU ING STREETS) BUILDING t a U 0 In W PLUMBING W O � 0 W 0 MECHANICAL -1 FENCE F m "Applicant, on behalf of his or her spouse, heirs, assigns and SIGN 2 J successors in interest, agrees to indemnify, defend and hold harmless i E the City of Edmonds, Washington, its officials, employees, and RETAINING WALL i E 0 Q agents from any and all claims for damages of whatever nature, u x arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL D ance of this permit shall not be deemed to modify, waive or reduce p any requirement of any city ordinance nor limit in any way the = City's ability to enforce any ordinance provision." I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE e, formation given is correct; and that I am the owner, or the duly author- 1f L 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 YeGr(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.) vided. SIGNATURE (OW R OR AGENT) DATE IGD INSPECTION _ DEPARTMENT DIRECTOR'S IGNAS{IR N CITY OF �JI EDMONDS DATE This Permit covers work to be no on private property ONLY, 775 2525 �Q Any construction an the public domain (curbs, sidewalks, driveways, marquees, etc.) will require separate permission, ATTENTION ORIGINAL — File YELLOW — Inspector IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL. INSPECTION HAS BEEN MADE AND APPROVAI, OR A CERTIfICari ;V n"',!JPA%L:: iln!: ;;4.N Gli;.:':LD UBC:304, 3w. r 11V I\ — VVVnm VVLII — MStit'11U1