790567.pdfBUILDING DIVISION
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
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N "Applicant, on behalf of his or her spouse, heirs, assigns and
j successors in interest, agrees to indemnify, defend and hold harmless
M the City of Edmonds, Washington, its officials, employees, and
a agents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
D ante of this permit shall not be deemed to modify, waive or reduce
pany requirement of any city ordinance nor limit in any way the
= 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 am 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 YeOr(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.)
USE PERMIT
ZONE NUMBER
Joe ADDRESS
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790567
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY
3UBLIC IMPROVEMENTS REQUIRED ❑
7RAINAGE IMPROVEMENTS REQUIRED ❑
3RAINAGE PLAN REQUIRED ❑
JNDERGROUND WIRING REQUIRED ❑
=ONNECTION TO SANITARY SEWER ❑
;EPTIC TANK PERMIT REU'D ❑ NO.
ELEVATION OF PROPERTY CORNERS ❑
& FOOTINGS REQ'D
SEE ENGINEERING MFMO DATED 1"
CHECKED aY
SIGN AREA
ALLOWED I PROPOSED
REMARKS
Y
ENV. REVIEW
PLETEI EXEMPT
r
R CU PLANNING REVIEW BY DATE
ram/ / n LOT COVERAGE
ONT (V INSIDE REAR
TYPE OF CONSTRUCTION CODE HEIGHT
MEcNAUIcAL ��17�
PECTOR AREA OCCUPANCY OCCUPANT
GROUP ('7 LOAD
❑ NO vz��
PLJ1N CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
This Permit coven work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquess, etc.) will require separate permission,
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.
102.78
EE
HECK FEE
BUILDING
PLUMBING
VALUATION I FEE
MECHANICAL
FENCE ---
SIGN
RETAINING WALL
SWIMMING POOL
AL AMOUNT DUE I I a:i:�' 7 00
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit
AUTHORIZES until signed by the Building Official or
ONLY THE his Deputy; and fees are paid, and
WORK NOTED receipt is acknowledged in space pro.
INSPECTION vided.
DEPARTMENT DIRECTOR'S SIGNATURE
CITY OF (�Q,�•Q�
EDMONDS GATE
775-2525 1 S 1 7 9
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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