820007.pdfI• a
UST: PERMIT
CITY OF EDMONDS LON1. �•J NUMUL❑ 7
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BUILDING PERMIT APPLICATION
NAME JOR NAM C OF 13USINESSI SHOR SUIT NO,
LEGAL DESCRIPTION SUIIDIVISlO�
W MAILIN ADDRESS
v PUBLIC II LIC RI OF WAY PER OFFICIAL STHELT MA
O CITY L•� 1 TELEPHONE NUMBER Z
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U a CITY TELEPHONE NUM OCR t MARKS
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•ONE NVMUER
It CITY
z �i�.vt o rJ✓� S 3 CY LICENSE NUme
U STATE LICENSE NUMBEF
E UNITS
ENV. REVIEW
AOu NO.
SIGN AREA
ALLOWED PROPOSED
COMPLETE EAEMPT
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SHORELIN[
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'ARIANCE OR CU
PLANN REVIEW BY
DATE
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LOT COVERAGE _
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iEM ARKS
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❑ NEW
SIDENTIAL
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❑ PLUMBING CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
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ESIOEN TIAL
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❑MECHANICAL
OCCUPANCY OLCOCAUOPANT
ERADp
SPECIAL INSPECTOR AREA
DEMOLISH ❑SIGN q EOUIREDCAVAGROUP 1L r J
J YES ❑ NOon
❑ ALTER FX FILL TE ❑ FENCE X—FT) REMARKS
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INSP./ SWIM V 1��
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PR•MOVE ��
❑ REPAIR E
❑ COMPLIANCE INSP. ❑POOL
NUMBER OF STORIES NUMBER OF
L DWELLING
UNITS
F
6 NATURE OF WORK TO BE DONE (ATTACH PLOT PLANT
N
W
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PLAN CHECK FEE
VALUATION FEE
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BUILDING
PLUMBING
/
MECHANICAL
This Permit covers work to he done on private property ONLY.
the domain lcurbs, sidewalks, driveways, FENCE
Any construction on public
etc.I Will require separate permission.
marquees, SIGN
Permit Application: 180 Days
Work Is Started Within 120 Days RETAINING WALL
Permit Limit: 1 Year • Provided
N ";IPPhe:llll, Ill) Ot Ill' Of her �p"l„l', heir, a igl„ all' SWIMMING POOL
W Iil IIIICtI''t. :IgIC,'' It, Indela,jiiy, lll'lClld and hold harnile"
it
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C agClll' irnill atl)' !"Id all l'lal"" t"I Il:l lll:lg,'' OI \\'ll:l lel'et Ilature.
l�'II•
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i :l tking dlrleth Or inducol). if011l Illy 1"11;1I1ie OI Illy flilll.
waive "r reduel' TOTAL AMOUNT DUE
D ance u( this pvrmil 'hall ,,It he deenlad I" modily,
any retlaitcmetll 'It' a0' fig>' ordinancr nor limit it, any "a'.he
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APPLICATION APPROVAL
I Cay'' ab11111' III e111llrel' :III)' Ofliinal il' PrO''I+i011. ATTENTION
I Ilereby alkmlw'ledge that I II:IY,' ICad I'll, :IPPIICati"m llim Tile ill- THIS PERMIT
riiis application Is IIU( a permit
I"Inlallll" gl'','11 1, e,lrrect: alld ill at I'it,, Ilie O\\'11,`f, ,t the dlll)' atilh"r AUTHORI2 ES
Suite` l:"vs t,'gll•
ll"III s11;11ed 11�' II1C Building Official Or
and
ll!'d age 111 "i Ille 11.1ler, I ag,ee' In e"Illp IY with iil\' and
ONLY THE
in doing: the work authotited thereby', n" pel'"n
Ills Depllt V; all l) ices :1(C p31(l,
I\ :lil:illlw'l!'l1tI.L`l1 111 space pro-
Wing t"nstn,etion; and
will be emp1"yed in violali"n "( file Labor Code "I till' State OI Wa'hingi"ll WORK NOTED
vlllcdreceilt
n•Ialing hl Iyorkmen'' C'onlpt n sari"" In'lltance.
AGENT)
SIGN—
INSPECTION
OAT BIG ED pEPART,MENT
OIHEC R'S SIGN A'fURE
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M
.A.—.
` iE/ CITY OF
\• 1�.1 Q1�'L ,(
/ /
EDMONDS
DATE
2�
' THIS SITE IS LOCATED
IN THE CITY 775.2525
/ I �'
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ORIGINAL 1'11r YELLOW - lospector
ATTENTION
OCCUPY A BUILDING OR STRUCTURE.
PINK — Ownl'1 GOLD — Assussnr
to
IT IS UNLAWFUL TO USE OR [
Dl..v S RI=Cf1
HAS BEEN AGRAN DE RE
A FINAL
HAS BEEN PECTION
ED. UBC0304`30R.
AUNTIL
CERTIFICATE OFSOCCUPANCY
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DEC 14 FM
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Appriom DATE. IL 0 lei
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