800361.pdfUSE PERMIT
PERMIT
DIVISION Applicant Fill ZONE NUMBER
PERMIT APPLIC�T�ON Inside Heavy lines
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TELEPHONE NUMBER
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CITY LICENSE NUMBER
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Legal Descrlption of Property Show fselow or Attach Four Copies)
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REPAIR 0IrJSPMOVC ❑PCOL.
UMBER OF STORI NUMSCR OF
DWELLING
UNITS
ATURE OF WORK TO BE DONE
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F�1_An1S
LEGAL DESCRIPTION
SUBDIVI, ON
S IORT SVB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY 1
—
1
PUBLIC IMPROVEMENTS REOUIREO ❑ f
DRAINAGE IMPROVEMENTS REQUIRED ❑
DRAINAGE PLAN REQUIRED ❑
U N OERGROUND WIRING REQUIRED ❑ I
CONNECTION TO SANITARY SEWER ❑ 1
SEPTIC TANK PERMIT REO'D ❑ No.
ELEVATION OF PROPERTY CORNERS ❑
& FOOTINGS REO'D ,
SEE ENGINEERING MEMO DATED —
CHECKED BY
METER SIZE
BUILDING sLIFPLY SIZE
REMARKS
i`zT iQ-2 47GRV1tE.
SIGN AREA
ENV. REVIEW
ADD NO.
ALLOWED PROPOSED
COMPLET EXEMPT
SHORELINE
N,,_
REMARKS
VARIANCE OR CU
PLANNING REVIEW BY
DATE
DS
LOT COVERAGE
5' FRONT 510E REAR
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ZONE
TYPE OF CONSTRUCTION GODC
HEIGI>p
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M
IAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
UIRED
GROUP—� LOAD
ESN
CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
tF
SHOULD BE CODED 31.04.
ARKS
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1" I NVGr—RoC�RtiSs
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ry a.nc — I VALUATION I FEE
BUILDING
MECHANICAL
la "Applicant, on behalf of his or her spouse, heirs. assignsI
and
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SIGN
—
W suCCCSSDfS In Inttre5l. agrees to indemnify, defend and hold harmless
U employees.
I the City of Edmonds, Washington, its officials,
RETAINING WALL
[ agents from any and all claims for damages of whatever na,
pSWIMMING
r arising directly or indirectly from the issuance of this permit. -
POOL
D ante of this permit shall not be deemed to modify, waive or ree
0 any requirement of any city ordinance nor limit in any waye
i City ability to enforce any ordinance provision."
Qp
I hereby acknowledge that I have read this application; that in.
TOTAL AMOUNT DUE
formation given is correct; and that 1 ant the owner, or the duly aor-
ized agent of the owner. 1 agree to comply with city and state lawu-
ATTENTION
APPLICATION APPROVAL
latingconstruction; and in doing the wurk authorized thereby, no onwillbe employed in violation of the Labor Code of the State ofWashon
THIS PERMIT
This application is not a permit
relating to Workmens Compensation Insurance.
AUTHORIZE!
until signed by the Building Official or
NOTE: Permit Matt One Year(Except DEMOLITIONS anLL
ONLY THE
his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be complete90
WORK NOTED
receipt is acknowledged in space pro.
days; MOVED -IN BUILDINGS shall be completed in six ms.)
INS►[CTION
Yided.
SIGMA UR[ OWNER OR AGENT
DOT[ SIGNEDEPARTMENT
�
CITY OF
DIRE) OR'S SIGNATURE
EDMONDS
OAT[
This Permit cover* work to be done on privota ppropeny ONLY.
Any construction On the public domain Iourbs, slrlewalk*, driveways,
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tmrquese, etc.) will require went* permission.
77 61.J
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
ORIGINAL — File YELLOW — inspector
61l9 of 11'M0H14 PINK —Owner GOLD — Assessor
PtntiNlNt; UEPT,
M
UNTIL A FINAL INSPECTION HAS BEEN ADE AND APPROVAL OR
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A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC 304, 306.
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..J�%��,1 �,...4.+4.-..•., 1 'V�IriN�V� 11� B. DARNEL 1 1I1 I _
GENERAL BUILDING CONTRACTOR
�Cj��!{��OL�1'I �,/1 vl �/1�f I/�, .•�iy MQNDV 1I '�?P.Lt'PNONP. 776.0790