790312 (2).pdf'1
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BUILDING DIVISION Applicant Fill
PERMIT APPLICATION Inside Heavy lines
NAME (OR NAME OF BUsimessi
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AILING ADDRESS
CITY ELlPH ONE NUMBER
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NAME
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ADD E S
CITY TELrE PPHONE NUMBER
NAME / c( l
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ADDRESS
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PERMIT
ZONE'`NUMBER 12� �(., 1�'.i •'..
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ADDRESS ('r�.`�J � '�If�
LEGAL DESCRIPTION 'SUBDIVISION r(_ SHORT SUBNO,
PUBLICRIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING I
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PROPOSED_
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED ❑
DRAINAGE IMPROVEMENTS REQUIRED ❑
DRAINAGE PLAN REQUIRED ❑
UNDERGROUND WIRING REQUIRED ❑
CONNECTION TO SANITARY SEWER
SEPTIC TANK PERMIT REQ'D ❑ NO,
ELEVATION PROPERTY CORNERS ❑
6 FOOTINGG S REQ'D
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TELEP7HONE NUMBER
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SEE ENGINEERING MEMO DATED
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STATE LICENSE NUMBER CITY LICENSE NUMBER
CHECKED BY __
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Legs Description of Property (Show Below or Attach Four Copies)
METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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SIGN AREA ENV. REVIEW ADa NO.
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ALLOWId ED PROPOSED COMPL ET EXEMPT
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REMARKS
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VARIANCE OR CU PLANNING REVIEW BY GATE
YARDS \ I LOT COVERAGE
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FIRE ZONE TVPE O.Vp F�II ?COrNSTR�JLTION EPC HEIGHT
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NON-RE51 DENTIAL ❑ SIGN
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❑ ADD ❑
DEMOLISH ❑ WALLI NING
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SPECIAL REQUIRED SPECTOR AREA OCCUPGROUP IANCY
❑ ALTER EXCAVATE FENCE
OR FILL ❑ 1_ x_FTj
LOAJOC D
❑ YES NO M� Z
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pLAN CHECK D BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
REPAIR PRE -MOVE sw1M
O INSP, POOL
SHOULD BE CODED 31.04.
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= NUMBER OF STORIES NUMBER OF
REMARKS
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F UNITS
NATURE OF WORK TO BE DONE
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ui "Applicant, on behalf of his or her spouse, heirs, assigns and
SIGN D
It successors in interest, agrees to indemnify, defend and hold harniless
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F the City of Edmonds, Washington, its officials, employees. and
RETAINING WALL f
a agents From any and all claim s for damages of whatever ml ture.
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I arising directly or indirectly from the issuance of this pernlil. Issll-
SWIMMING POOL 5 00G 10
0 ante 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 I (✓ U—
formation given is correct; and that I 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 Yearlh:.cept DI:+IouTIONS and FILL
ONLY THE his Deputy. and fees are paid, and
PERMITS without conditional use permil. N'hlch shall be completed in 90
WORK NOTED receipt is acknowledged In space pro -
days: Id O�•ED-INILDINGS shall he completed in six months.)
vided.
NBUER OR NT) DATE SIGNED
SIGNATURE low
INSPECTION
DEPARTMENT DIRECTO 5 51GN�
b
CITY OF
EDM ONDS DATE
This Permit coven work to be done on private property ONLY.
Any construction on the public domain leurbs, sidewalks, driveways,
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marquees, ate.) will require separate permission.
ATTENTION
ORIGINAL - File YELLOW- Inspl!ctor
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
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PINK - Owe, GOLD - As issor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306
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HE^1O TO: [3ui ] cli.nf; Di vi.s i c>tl 790? i %.
Community Deveiopment.Dcp,artment
FROM; En;ineerinf, Division
Public Works Department
SUBJECT: Z, 171 -- `1 S`I4- P _ , Uj .
After revic�,� of the subject building pertni.t ai�.plication, we have
the following comments:
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