790101.pdfE PERMIT
BUILDING DEPARTMENT Applicant Fill ZONE �� NUMBER 790101
PERMIT APPLICATION Inside Heavy Lines
ADDRESS �� CC� A -I e�
NAME IOR NAME OF BUSINESS) C
C T C 1( Ir1 w 1 ` r`,� 1 �' ` I L ♦r v LEGAL LOT PLAT NAME SUBDIVISION NO.
W MAILING ADD17R_EISSSE-ti HaN Ir7�jt V. 1✓�Y Ur21vY ❑YES ONO
0000 LJ}+1 It G `I INMLO ) 1zI, V PUBLIC RIGHT OF WAY PER ORDINANCE NO.
CITY ELEPHONE NUMBER
EXISTING RIGHT OF WAY
NAME 6 1 PROPOSED RIGHT OF WAY
I„ DEFICIENCY OF RIGHT OF WAY
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F ADDRESS STREET/UTILITY WORK REQUIRED ❑YES NO
i PERMIT FOR WORK IN PUBLIC R/W ❑YES NO
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E CITY TELEPHONE NUMBER UNDERGROUND WIRING REQUIRED ❑YES ONO
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- ,` y� CONNECTION TO SANITARY SEWER DYES El NO
NAME pec". cou &J %„ SEPTIC TANK PERMIT REQUIRED OYES ONO
1 Doo IZ C L I &a Cc o IZOI, I SEPTIC TANK PERMIT NO,
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Q ADDRESS
SEE MEMO DATED N
�( < 23 14- 45AMs 5PoKWZ'. 5T
E CITY TELEPHONE NUMBER REMARKS
S� t t JN A. 48 io 6 9'31- 9 130
U STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BY
T13- 02.- 4304-
Legal Description of Property (Show Below or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE
REMARKS
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F SIGN AREA ENV. REVIEW ADD O.
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C ALLOWED PROPOSED COMPLET EXEMPT
H SHORELINE
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G REMARKS IVD Eot EP (j)
0 4Ra.)tBer �o�c Rtx�� t _.► ��- .
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
FRONT SIDE REAR
❑ GAS
NEW RESIDENTIAL LINE FIRE ZONE TYPE OF CONSTRUCTION JCODE,, .� { HEIGHT
NON-RESIDENTIAL ❑ SIGN MIS �.�• ���./ t)�
El ADD vv
❑ DEMOLISH ❑RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
WALL REQUIRED GROUP 2 Z-3 LOAD
❑ ALTER EXCAVATE FENCE ❑ YES LjY NO
OR FILL ( X_FT) PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS, LOCAL SALES TAX
REPAIR ❑ INSP. O POOL SHOULD BE CODED 31.04.
NUMBER OF STORIES NUMBER OF REMARKS
Z DWELLING ��
O OO
F UNITS
a NATURE OF WORK TO BE DONE
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O PLAN CHECK FEE VALUATION FEE
-' PROPOSED USE
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PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING
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W PLUMBING
O MECHANICAL LT 16
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FENCE
"Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
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W successors in interest, agrees to indemnify, defend and hold harmless
-I successors
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f the City of Edmonds, Washington, its officials, employees, ces and RETAINING WALL
It agents from any and all claims for damages of whatever nature,
= arising directly or indirectly from the issuance of this permit. issu- SWIMMING POOL
o ance of this permit shall not be deemed to modify, waive or reduce
O any requirement of any city ordinance nor limit in any way the
x City's ability to enforce any ordinance provision." 'r l
I hereby acknowledge that I have read this application; that the in. TOTAL AMOUNT DUE ,� r Vv
formation given is correct; and that 1 am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
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 condition- It permit, which shall be completed in 90 WORK NOTED receipt is acknowledged in space pro -
day ; OVED-IN BUILDI GS shall be completed in six months.) vided.
SI A RE(OW OR AGE T) JDATE SIGNED INSPECTION
2 DEPARTMENT DIRECT R SIGNA RE
1 79 CITY OF
EDMONDS DATE
his Permit covers work to be done on private property ONLY. 775-2525 3 /
Ant construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ATTENTION MAR _ P iQ%q ORIGINAL —File YELLOW —Inspector
IT IS UNLAWFUL TO USE OF.. OCCUPY.A BUILDING OR STRUCTIIRF FIM! < r`. I Ont.D - A,,, , :L)l
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