810340.pdfUSC FERM
CITY OF EDMO S ZONE NUMBICIt 810340
S I
BUILDING
PERMIT APPLICATION
•
ooRE55
NAM OR NAMC F BUS CSfi� / ' I� I
LEGAL DESCRIPTION SUBDIVISIO SHORT UB NO,
��
i
I
JI
y 1� ` I(
✓✓✓ 1 1
I
tl
�._.. _...._
W
MAILIN A. HS
1I L I
e I I<
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY !LlPHONH NUMrgER
oK ( I y E%ISTING U
J +++777 Z
GYI
W
1.
I-
W
�/lY r FIl 1 DFFICIENCY OF RIGHT OF WAY
��V VVV l Z
ADDRESS '� CNECKEU OV O
F
2
/ 1$EE ENGINEERING MEMO DATED -- W
t 1`
U
C
3(�/
CITY TELEPHO E NUMBER REMARKS
—Re
`
f 1 J (Yt n 1 =tiQ n-T
NAME r-
Nf Vc
H
0
ADORSS METER SIZE BUILDING SUPPLV5IZE 1KTUREUNITS
F
a
C
uienjv
CITY TELEP O�E NUMBER REMARK$
7 P
U
STATE LICENSE NUMBER CITY LICE �5' NUMBER SIGN AREA ENV. REVIEW AOB NO.
1
ALLOWED PROPOSED COMPLETC E)tEM PT
1 SHORELINE #
i
Legal Description of Property (Show Below or Attach Four Copies) N
I
�
VARIANCE OR CU PLANNING REV BY PATE
D _O — lot 3
O
6003 l✓ • YARDS LOT COVERAGE Z
E
FRONT SIDE REAR Z
N
REMARKS
G
W
D
Q
ld
i
4
❑ NEW RESIDENTIAL ❑ PLUMBING CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
NON-RESIDENTIAL ❑MECHANICAL V
/
I
❑ ADD ❑
SPECIAL INSPE AREA
DEMOLISH ❑SIGN
REOUI RED�OR
GROUPAN`� OCCUPANT
❑
❑ ALTER ❑ ORCFILL A -ATE ❑ FENCE NO
Z
REMARKS
REPAIR ❑ PRE•MOVEINSP.j❑SWIM
COMPLIANCE INSP, POOL
1
Z
0
NUMBER OF STORIES NUMBER OF
pELLING `, `I vi
f
UW
NITS
C
a
NATUR OF WORK TO BE DONE (ATTACH PLOT PLPNI
u;t� �Qto�nd a 1 Di f M,I
cow,ale A77�
m
,'r+ pegh
D
PLAN CHECK FEE VALUATION FEE
'
BUILDING
PLUMBING
(
MECHANICAL
i
This Permit covers work to be done on private property ONLY,
i
Any construction on the public domain (curbs, sidewalks, driveways, FENCE
marquees, etc.) will require separate permission.
�•
SIGN
L.
�• 1
Permit Application: 180 Days
Permit Limit: 1 Year . Provided Work is Started Within 120 Days RETAINING WALL
�+
N :Applicant I),I behalf of Ili, or her %I,ou,,, betrs, as%igl11 and SWIMMING POOL
r W� successors in interest, agrees to indemnity, defend and hold Ilnrmles+
i the City ul Iidn%nds, W.,Ilington, it, ofliciah, lntployces, and
a:agents (tool any and all claints for damage.+ of what cvcl nature,
2 arising directly or illdltecilefrom the i"llance of IN, peritlil. Issu-
� I
a once of this penuit shall not he deemed to modify, waive or reduce TOTAL AMOUNT DUE
h
p any requirement of any City' ordinance nor limit in any a:Iy the
�(
APPLICATION APPROVAL
2 City's ability to enforce any ordinance pu»uBln. ATTENTION
I
I hereby' acknowledge that I Ila- read this application; that the in.
for ilt ati.n itwen i% cI)r reel; and that I a;i,; the owner, or file dilly author. THIS PERMIT
This application Is not '1 pe.rlilit
iLed -agent of lit, owner. I agree' to —,11 ly' with city and %late la+e'% tegll• AUTHORIZES
1111111 signed by till' Building 011lclal or
lating construction, and lit doing the work authorized thetcby, no peT%on ONLY THE
his Deputy; a11d Iles are paid, and
i
will be a 11 lye J in violat 6r, oI, the Lal"IT Colle of tile State If Wa+hingtml WORK NOTED
icce Ipt is acknowledged tit space pro•
j
rclati to York lc 's fnipen,ati%,11 Insu once.
Bided.
f
SIG TU I W R O AGE Ty r TE SIGNED INSPECTION
DEPARTMENT
PIR OR'S SI NATURE
CITY C
L. q ( • C.
i
EDMONDS
ATE
THIS SITE IS LOCATED IN THE CITY 775-2525
Q
OF EDMONDS. LOCAL SALES TAX
uu
SHOULD BE CODED 31.04.
ORIGINA - F,Ie YELLOW In.peetnr
ATTENTION
I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK — Owner GOLD
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
1a2 Te
J
{
M