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BUILDING DIVISION i iv�ry
Applicant Fill ZONE _1^ NUMBER
PERMIT APPLICATION Inside Heavy Lines JOB
WA�+ME (OR NAME OF BUSINESS) ADDRESS IQ�O2 O r plc 1 it=w
LEGAL DESCRIPTION I SUBDIVISION SHORT SUB NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
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 OF PROPERTY CORNERS ❑
& FOOTINGS REQ'D
SEE ENGINEERING MEMO DATE
Legal Description of Property (Show Below or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE
REMARKS
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;% atftviavc�(_w A L::rr3 SIGN AREA ENV. REVIEW ADB NO.
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ALLOWED PROPOSED COMPLET EXEMPT
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� fP VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
❑ NEW ®RESIDENTIALAS
FRONT SIDE REAR
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT
ADD
ElNON-RESIDENTIAL❑ SIGN
❑ ❑ RETAINING SPECIAL INSPECTOR AREA OCCUPANCY
El DEMOLISH
WALL REQUIRED GROUP LOAD LOAD
❑ ALTER EXCAVATE FENCE El YES ❑ NO
OR FILL l X_FT) PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF REPAIR ElPRE-MOVE
ElSS III SHOULD OBEDLOCAL SALES TAX
CODED31 04
REMARKS
Z NUMBER OF STORIES NUMBER OF
0 DWELLING
F UNITS
C NATURE OF WORK TO BE DONE
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O OPLAN CHECK FEE VALUATION FEE
li-, P, DT PLAN
BUILDING
PLUMBING
MECHANICAL
FENCE
in N "Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
W successors in interest, agrees to indemnify, defend and hold harmless
-1 y g employees, RETAINING WALL
i the City of Edmonds, Washington, its officials em to ecs, and
tt agents from any and all claims for damages of whatever nature,
I 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 LO/y\ PL,I AI%iCC—
o any requirement of any city ordinance nor limit in any way the I IVS1�Ec j\OPT ZS
x City's ability to enforce any ordinance provision."
I hereby acknowledge that 1 have read this application; that the in. TOTAL AMOUNT DUE
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. 1 agree to comply with city and slate 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 -xcept DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and
PERMITS without conditional use pe It, which shall be completed in 90 WORK NOTED receipt is acknowledged in space pro -
days; MOVED-0 BUILD GS s be completed in six months.) vided.
SIGNATUR WNE GE ) ]DATE SIGNED INSPECTION
..����11 ��77 DEPARTMENT DIRECTOR'S SIGNAT E
N7 CITY OF _L
EDMONDS DATE
Is 139WInit Lovers w to be done on private property ONLY. G'
y co ruction on t 775 2525
ublic domain (curbs, sidewalks, driveways, �— 4 7
marquees, ,) will require separate permission.
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
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