790175.pdfL
ING DEPARTMENT ApplicantFill
MIT APPLICATION Inside Heavy Lines
OR NAME OFBUSINESS)
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ADDRESS
rn I G VW IDS
ELEPHONE NUMBER
rn 5 Vv F0707
/ - 5,233
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NUMBER
790175
JOB n
ADDRESS
LEGAL LOT PLA/AT NTLYM E Y
❑YES El NO
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
BDIVISION NO -
STREET/UTILITY WORK REQUIRED ❑YES
PERMIT FOR WORK IN PUBLIC R/W ❑YES
TELEPHONE NUMBER UNDERGROUND WIRING REQUIRED OYES
CONNECTION TO SANITARY SEWER ❑YES
,p y^ SEPTIC TANK PERMIT REQUIRED ❑YES
LJ/ SEPTIC TANK PERMIT NO.
SEE MEMO DATED
TELEPHONE NUMBER REMARKS. &IZL�
or Attach
CHECKE
-/AO
SIGN AREA
ALLOWED PROPOSE
93 /6 R
REMARKS
VARIANCE OR CU
YARDS
J��j� NEW lJ RESIDENTIAL GAS
�IFRONT
j7 t❑� LINE FIRE ZONE
NON-RESIDENTIAL NI SIGN 2
❑ ADD ❑ fLJ O-1
DEMOLISH SPECIAL IN
� WALLI NING REQUIRED`
❑ ALTER ❑ EXCAVATE FENCE ❑ YES
OR FILL ❑ ( X_FT) PLAN CHECI
❑ REPAIR ❑ NSP. ❑Po L
Z NUMBER OF STORIES NUMBER OF REMARKS
O / DWELLING
F UNITS
LL NATURE OF WORK, TO BE DONE
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PLAN CHEC
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°vi "Applicant, on behalf of his or her spouse, heirs, assigns and
� successors in interest, agrees to indemnify, defend and hold harmless
E the City of Edmonds, Washington, its officials, employees, and
aagents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
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
x City's ability to enforce any ordinance provision.
I hereby acknowledge that 1 have read this application; that the in-
formation given is correct; and that 1 ant 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.)
SIGNATURE (OWNER OR AGENT) IUATE SIGNED
' K . I // // I/ / 17 Y\ i / V 1 �7 - // I,
I Ills 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 INSPFCTION HAS RGrn! MADL AND APPROVAL OR
A CERTIFic" rF :,1; j"I j'110 Ay,`Y 1.Inc nC cNMno Awl r"e
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
1c
RETAINING WALL
SWIMMING POOL
AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
REVIEW
1 EXEMPT
❑ NO
El No
❑ NO
El NO
❑ NO
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PLANNING REVIEW BY DATE
y-/o-
LOT COVERAGE
SIDE REAR
)F CONSTRUCTION CODE HEIGHT
1! f
%A / OCCUPANCY OCCUPANT
H�IJ-'71 GROUP p7 LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
SHOULD BE CODED 31.04. ?
r` 1 / foW r
VALUATION
FEE
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro.
vided.
DIRECTOR'S SIGNATURE
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ORIGINAL — File
PINK — n.vrwr
J
YELLOW — Inspector
GOLD — Assessor