810170.pdfUSE
~ CITY OF EDMONDS ZONE
BUILDING PERMIT APPLICATION —
NAME TOR NAME OF BUSINESS) ADDRESS
It Rl THE x, OSIER [ /Ii R D LEGAL DI
W MAILING ADDRESS
Z
PERMIT
NUMBER
8 10 1
•i Gz,2 S 0.6
V 1 C W
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
O CITY
ELEPHONE
NUMBER
E %ISTING
ED�o�yDs
77� i.z�
VfiOPOSED
NAME
DEFICIENCY OF RIGHT OI' WAY
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CHECKED BY
SEE ENGINEERING MEMO DATED_
R REMARKS
NAME
METER SIZE IeUILDING SUPPLY SIZE I FIXTURE UNI TS
ADDRESS
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SIGN AREA
E.V. REVIEW '-"•"-"
U STATE LICENSE NUMBER CITY LICENSE NUMBER
COMPLETE EXEMPT
ALLOWED PROPOSED
SHORELINE #
Legal Description of Property (Show Below or Attach Four Copiesl
VARIANCE OR Cu
PLANNING REVIEW BY DATE
Z
LOT COVERAGE U
O
YARDS
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FRONT
SIDE REAR Z
Z
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REMARKS
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NEW DENTIAL
PLUMBINGCHECKED
BY
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N-RESIDENTIAL
Ir7-7�fIPM ECH AN ICAL
ADD
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DEMOLISH
J.-�
SIGN
SPECIAL INSPECTOR AREA OCCUPANCY OCCUi
REQUIRED GROUP rf l� LOAD
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ES
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ALTER ❑
EXCAVATE
FILL
' ENCE X—�)
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AA.X — Per-
REPAIR
COMPLIANCE INS,.
❑ POOL
Z NUMBER OF STORIES
NUMBER OF
1,1,- VrTOLG REIN �
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DWELLING
UNITS
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n NATUREOFW RKTOBEDONE.IATTACH PLOT PLAN)
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VALUATION
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BUILDING
PLUMBING
MECHANICAL
This Permit coven wo. herk to be done on private property ONLY.
driveways, FENCE
Any �rletrT marquees, etc.) will requ ei seperete permission
SIGN
Permit Application: 180 Days
Permit Limit:1 Year- Provided Work is Started Within 120 Days RETAINING WALL
h "Applicant, can behalf (iI his or her sptluse, hells, assigns alld SY IMMING POOL
W successors in Interest, agrees to indetnnify, defend and hold harmless
J
P the City of Edmunds, Washington, its officials, employees, and
E agents from any and all claims fnr d:mlages of tt•h;rtever nature,
a issuance of (his 11 titlit. Isslr
t% CCJ-
x :wising directly or indirectly fiscal the
active or reduce TOTAL AMOUNT DUE
(lJ
p ance of This perntil shall not he deemed (o modify,
'ally lIt lit ill any Way' lie
J any requirement ofCity ordinance nor
APPROVAL
i City's ability to enlbrce any ordinance provision" ATTENTION
APPLICATION
I h2rcb)acknowledge that I have read this application that the 111• THIS PERMIT
Till$ uplllliallUll is IIUI - a Iieltll ll
formation given is eltrrel'l; and It at I :Till'he "caller, car the la aI1
until signed h till Building' Official or
g '
1e rcgu• AUTHORIZES
iLed agent of the "Weer. I agree I en.111,I)' Willi ail)' and Malt' laws rl gV-
and alld
11is Depull'. IeeS are paid,
lating construction; and In doing Zile work authoriied thereby', it,, person ONLY THE
Lab+u f-(ids' RI till' Stall` of Washington WORK NOTED
lel'L'ipt is acc� llowledged Ill space IIr0-
be employed in violation of ilia
Vlded.
relating to Workmen , i'Itillp'nSallull In+llr:mce' INSPECTION
SIGNATURE (OWNER AGENT) ' DATE SIGNED DEPARTMENT
DIRECT R'S SIGNATURE
/OR
G.l 3 - J �� CITY OF
U,�ILI�
syL�Cc Gam'-t�-f •-' eLii
EDMONDS
DATE
HIS SITE IS LOCATED IN THE CITY 775-2525
�u(
OF EDMONDS. LOCAL SALES TAX
SHOULD 13E CODED 31.04.
ORIGINAL - Flu YELLOW In••PI'�'I�++
ATTENTION
TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK — Uwnel GOLD — Aurssot
IT IS UNLAWFUL
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304. 306.
1a2 IN
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