780604.pdfBUILDING DEPARTMENT Applicant Fill USE PERMIT
PERMIT APPLICATION Inside Heavy Lines ZONE ` (Z NUMBER JOB 060 784
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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
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0 CI '- PUBLIC RIGHT OF WAY PER ORDINANCE NO.
TELEPHONE NUMBER
EXISTING RIGHT OF WAY
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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
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CONNECTION TO SANITARY SEWER ❑YES El NO
0
NAMEr, SEPTIC TANK PERMIT REQUIRED El YES El NO a
SEPTIC TANK PERMIT NO.
0 ADDRESS
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U SEE MEMO DATED
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E CITY TELEPHONE NUMBER REMARKS
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UrWT `ELICENSE NUMBER CITY LICENSE NUMBER CHECKED BY
Legal Description of Property (Show Below or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE
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REMARKS Q
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SIGN AREA ENV. REVIEW ADS NO.
E ALLOWED PROPOSED COMPLETE EXEMPT
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WREMARKS
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VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
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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
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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
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a NATURE Of WORK TO BE DONE �
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0 PLAN CHECK FEE 0
PROPOSE USE VALUATION FEE
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PLOT PLAN (INDICAffE BUILDING SETBACKS,
ABU ING STREETS) BUILDING t a
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0 MECHANICAL
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FENCE
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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
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