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BUILDING DIVISION
Applicant Fill
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T.ONr ;~�L NUM111'1! 8 ll 223
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PERMIT APPLICATION
Inside Heavy Linos
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LEGAL DESCnIPTION SUIIUIVI ION SHORT SUB NO.
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PUBLIC IMPROVEMENTS NCW UINEO (_
ORAINAGC IMPNOVEM NT�i REGUIREU
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TELEPHONE NUMBER
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CONNECTION 10 tiANIT ANY •i l'W EN C_�
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SEPTIC TANK P NMIT .ED TO I.i No. -
() ADDRESS
ELEVATION OF PHOPERT V CORNERS LI
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CITY
TELEPHONE NUMBER
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SEE ENGINEERING MEMO DATED__.13- -
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CITY LICENSE NUMBER
CHECKED By -
Loyal Description Of Property (Show Below Or Attach FOUf Copiesl
M LTEA SIZE BUILDING SUPPLY SIZE
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REMARKS
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ENV. REVIEW ADB NO.
SIGN AREA A,
iALLOWED
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PROPOSED COMPLET EXEMPT SMOF ELINE
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REMARKS
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VARIANCE OR CU PLANNING REVIEW BY DATE
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YARDS LOT COVERAGE
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Q NEW LJ N6S10[NTIAL
GAS
❑ GAS
FIRE ZONIRONTTVPE OF CONSTRUCTION CODE HEIGHT
❑ NO N•R lSIDCN
TIAL ElSIGN
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1 yT A00 DEMOLISH
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HIND
❑
SPEC IAL INSPECTOR AREA OCCUPANCY O[CVPANT
REQUIRED / GROUP LOAD
ALL.
WALL
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❑ YES d/NO 1
a.ORCAVAT!
A TIR
ow RILL
❑ FENCE (�� R PT)
PLAN CHECKED By THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
REPAIR ❑PR[ -MOVE
OSWIM
SHOULD BE CODE. 3T.04.
INSP.
POOL
REMARKS
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NUMBER OF STORIES NUMBER OF
DWELLING
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UNITS
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NATURE OF WORK TO BE DON!
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PLAN CHECK FEE VALUATION FEE
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� PLOT PLAN
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BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
"Applicant, on behalf of his or her spouse, heirs, assigns and
v,
W successors in interest, agrees to indemnify, defend and hold harmless
J
RETAINING WALL
i the City of Edmonds, Washington, its officials, employees, and
E agents from any and all claims for damages of whatever nature,
SWIMMING POOL
y p
x arising direct) or indirectly from the issuance of this
Induce
ante of this permit shall not be deemed to modify, m
any requirement of any city ordinance nor limit in any way the
O
s City ability to enforce any ordinance provision."
1 hereby acknowledge that I 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 state laws regu•
ATTENTION
APPLICATION APPROVAL
lacing construction; and in doing the work authorized thereby, no person
willbe employed in violation of the Labor Cude 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 Ono vfidr(Except 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 pro -
days; MOVED -IN BUILDINGS shall be completed in six months.)
INSPECTION
vided.
SIGHATU�NSR OR AGENT
OAT- SIGN[O
DEPARTMENT
DIRE C R'S SIGNATURE
�f`
3 .1 7191
.I•`'
(This
EDMONDS
DATE
Pamlt work to bo done on Prlvat[ ppropartV ONLY.
construct on tM puWla domain laurb, s{dewalW, driveways,
-y �Tt70
MAY U
marques, am) will require aeparata permission.
POaY
PW G
ORIGINAL — File YELLOW — Inspector
ATTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE CITY Oi LUMONDS PINK —Owner GOLD —Assessor
IT DE AND APPROVAOR PLANNING DEPT.
A FINAL PECTION HAS BEEN AGRA
AUNTIL TED, UB 304L306.
CERTIFICATE OFSOCCUPANCY HAS BEEN
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