790120.pdfa
BUILDING DEPARTMENTUSE PERMIT
Applicant Fill ZONE A \ NUMBER
PERMIT APPLICATION Inside Heavy Lines\V!
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NAME (OR NAME OF BUSINESS) ADDRESS/it ��
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LEGAL LOT PLA NA SUBDIVISION NO.
N DR I ALL ti L I Nn
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W MAILING ADDRESS ❑YES ❑NO
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0 CITY ELEPHONE NUMBER PUBLIC RIGHT OF WAY PER ORDINANCE NO.
DI'►'lo �/ !'l L+ 7 76 —c;k ` EXISTING RIGHT OF WAY
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PROPOSED RIGHT OF WAY
UDEFICIENCY OF RIGHT OF WAY
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ADDRESS STREET/UTILITY WORK REQUIRED ❑YES ❑NO
FOR WORK IN PUBLIC R/W ❑YES NO
CITY EPHONE NUMBER UNDERGROUND WIRING REQUIRED ❑YES [INC)
CONNECTION TO SANITARY SEWER ❑YES El NO
NAME C SEPTIC TANK PERMIT REQUIRED ❑YES ❑NO
(¢/Z/2//V v/LLB �i6i✓ �� , SEPTIC TANK PERMIT NO.
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SEE MEMO DATED
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CITY
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TELEPHONE NUMBER REMARKS
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STATE LICENSE 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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I.REMARKS
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SIGN AREA ENV. REVIEW ADB NO.
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REMARKS
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VARIANCE OR CU NNING REVIEW BY DATE
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YARDS LOT COVERAGE
NEW RESIDENTIAL FRONT SIDE REAR
❑ GAS
ElLINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT
NON-RESIDENTIAL ® SIGN
❑ ADD ❑ DEMOLISH
❑ RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
WALL REQUIRED GROUP LOAD
❑ ALTER ❑ EXCAVATE FENCE ❑ YES ❑ NO
OR FILL ❑ t X FT)
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
❑REPAIR PRE -MOVE swim OF EDMONDS, LOCAL SALES TAX
INSP. POOL SHOULD BE CODED 31,04.
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NUMBER OF STORIES 7NUM13ER OF REMARKS �1 ��,///
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UNITS
NATURE
URE OF WORK TO BE DONE
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PLAN CHECK FEE
PROPOSED USE VALUATION FEE
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"Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
successors in interest, agrees to indemnify, defend and hold harmless
the City of Edmonds, Washington, its officials, employees, and RETAINING WALL
agents from any and all claims for damages of whatever nature,
arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL
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ance of this permit shall not be deemed to modify, waive or reduce
any requirement of any city ordinance nor limit in any way the
City's ability to enforce any ordinance provision."
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1 hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given is correct; and that 1 am the owner, or the duly author-
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ized agent of the owner. 1 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
relating to Workmen's Compensation Insurance.
• AUTHORIZES
NOTE: Permit Limit One YeGr(Except DEMOLITIONS and FILL ONLY THE
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED
days; pliurvED-IN BUILDINGS s 1 be completed in six months.)
SIGN UR AGE ) DATE SIGNED INSPECTION
Q DEPARTMENT
CITY OF
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receiot is acknowledged in space pro -
vided.
DIRE
EDMONDS
This Permit coven work to be done on private property ONL . ]75 2525 Any construction on the public domain (curbs, sidewalks, driveways,
DATE
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marquees, etc,) will require separate permission.
ATTENTION
ORIGINAL — File YELLOW — Inspector
IT IC Ilntl AWFIII Tn IMP no nrrllov A Milli nlnlr_ no C7011PY110C
UNTIL A FINAL
INSPECTION HAS
BEEN MADE
AND APPROVAL OR
A CERTIFICATE
OF OCCUPANCY HAS
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.: ":Trn UBC 304, 30fi.
PINK — Ul'Oner GOLD — Assessor