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BUILDING DIVISION
Applicant Fill
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PERMIT APPLICATION
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NAME (OR NAM[ OF OUfIN[3S)
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❑ ADO
❑ ALTER
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❑ O[MOL19N ENTIAL
❑ ORCFILLTC
❑SIGN '
WALL NING
PENCE X_FTI
R [FAIR
INSP.-MOVC
POOL
NUMO[R OF STORIES
NUMBER OF
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DWELLING I
UNITS
NATUR( OF WORK TO BE DONE
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PUBLIC Of' WAY PC" OFFICIAL STREET MAP
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OLI'IC 11'NCV Uf NIG11T Of WAY
PII III_Ir IMPROVEMENTS REOUIRLD ❑
DRAINAGE IMPROVEMENTS REQUIRED ❑
OHAINAG[ PLAN RLOUIRED XPMC\B 1 ;L4
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N UE HGIt OIINO WI".- REOUIRCD S
CONNFCTION TO SANITARY StWEH In
SEPTIC TANK PERMIT REO'D 0 NO.
ELEVATION OF PROPERTY CORNERS ❑
U FOOTINGS REO'D
SEE ENGINEEnING MEMO GATED— `z
CHECKED IIV
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METER IZE
BUI ING SUPPLY SIZE
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REM R S
SIGN AREA
ENV. REVIEW
on NO.
ALLOWED PROPOSED
COMPLET EXEMPT
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SHORELINE
REM ARHS Q.1 ('t -T Gv-r'CIJr INTp
FRoN'T nsofLS TNa(y ,
VARIANCE OR CU PLANNING REVIEW BY
DATE
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LOT COVERAGE
J T FRONT /d SIDE 7_5 REA
FIRE ZONE
TYPO OF CO S UCTION CODE
HEIGHT
SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
REQUIRED
GROUP 7Z�3 LOAD
❑ YES NO
PLAN CHECKED eY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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m "Applicant on behalf of his or her spouse, heirs, assigns and
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III successors in interest, agrees to indemnify, defend and hold harndcss
_-_-_--_ 1
1 the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
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Iz agents from any and all claims for damagel of whatever nature,
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x arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
0 ante of this permit shall not be deemed to modify, waive or reduce
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0 any requirement of any city ordinance nor limit in any way theQbr
z City's ability to enforce any ordinance provision."
1 hereby acknowledge that 1 have read this application; that the in-
TOTAL AMOUNT DUE
3
t-ormation given is correct and that I am the owner, Or the duly author-
d
ized agent of the owner. 1 agree to comply with city and stale laws regu.
lating construction; and in doing the work authorized thereby, no person
ATTENTION
APPLICATION APPROVAL
willbe employed in violation of the Labor Code of the State of Washington
THIS PERMIT
This application is not a
relating to Workmen's Compensation Insurance.
AUTHORIZES
permit
until signed by the Building Official or
NOTE: Permit limit One iearlEscept DEMOLITIONS and FILL
ONLY THE
his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED
receipt is acknowledged in space
days; MOVED -IN BUILDINGS shall be completed m six months.)
pro.
vided
SIGNATURE OWN[R ON AG[NT) -
DgTC fiGN6O
INSPECTION
DEPARTMENT
DIR ECTOH'S T
CITY OF
E DMONDS
DAT•e
This Permit COYM work to be don. on private property ONLY,
Anv mnetruction on the public domain (curbs, sidewalks, driveways,
ii5.2525
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msrquaes, ate.) will require MPerate permission. D
ATTENTION ORIGINAL - Flle YELLOW - Inspector
IT 19 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINK - Owner GOLD - Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC304, 300.
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