830360.pdf, 5_/jo
BUILDING DIVISION
- PERMIT APPLICATION
EllOR NAME OF BUSINESS)
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Legal Description of Pr
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1GAL DESCRIPTION SUBDIVISION SHORT SUB NO. 4
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erty (Show Below or Attach Four
PUBLIC RIGHT OF WAY PEI, OFFICIAL STRECT
MAP
EXISTING
PROPOSE.
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
❑
DRAINAGE IMPROVEMENTS REQUIRE-
❑
DRAINAGE PLAN REQUIRE.
❑
UNDERGROUND WIRING REQUIRED
❑
CONNECTION TO SANITARY SEWER
❑
SEPTIC TANK PERMIT REO'D ❑ NO.
ELEVATION OF PROPERTY CORNERS
❑
A FOOTINGS REO-
SEE ENGINEERING MEMO DATED
.CHECKED BY
SIGN AREA ENV. REVIEW ADB N
ALLOWED I PROPOSED COM PLETEI EXEMPT
J
OR CU
PLANNING REVIEW BY DATE
LOT COVERAGE
1
FRONT
SIDE REAR
-(
I JrI NEW L]l RESIDENTIAL
El LINE
TYPE OF CONSTRUCTION CODE HEIGH'1
❑ NDN-RESIDENTIAL
Cj SIGNGA
_❑
ADD
RETAININGSPECTOR
FR�ARKS
AREA OCCUPANCY OCCUP❑
GROUPLOAD
ALTER OR FILL
W.ALL
❑ i ENCE )(—CKE❑D
BYO
THIS SITE IS LOCATED IN THE CITi
OF
A3104 LES TA)tPOOL
REPAIRINSPMOVE
❑SwIMSHOULD•
ED CODEDS.
Z NUMBER OF STORIES NUMBER OF
D DWELLING
F UNITS
a NATURE OF WORK TO BE DONE
VALUATION I FEE
BUILDING
PLUMBING
Uk0
MECHANICAL
FENCE
"Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
IIIsuein interestagrees to indemnify, defend and hold harmless
,
J , RETAINING WALL
i the City of Edmonds, Washington, its officials, employees, and
m agents from any and all claims for damages of whatever nature,
Q p SWIMMING POOL
directly or indileetly from the issuance of this ermit. ISM'-
x arising
0 an cc of this permit shall not be deemed to modify, waive or reduce
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a any requirement of any city ordinance nor limit in any way the /,�2
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x City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given is correct; and that 1 am the owner, or the duly author-
ised agent of the owner. I agree to comply with city and state laws regu- ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
willbe employed in violation of the Labor Code 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 11RUt One YeOP(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.
DIREC i AT
SIGNATURE (OWNfiR OR AGENT) .EPARTMENT
LOATE;IGNEO
d_5 CITY OF
EDMONDS
DAT
This Permit covers work to he done on privet! pproperty ONLY. 775-2525
driveways,
Any construction on the public domain (curbs, sidewallu,
/
ORIGINAL -File YELLOW -Inspector
lulon. ,00
nunquese, etc.) will require separate perml'F
ATTENTION
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK - Owner GOLD - Assessor
IT
DE
A FINALAND APPROVAOR
BEENAGRANTED.
A CEIRTIFICATE OFSPECTION OCCU OCCUPANCY HAS BE NHAS
UBC 304L30G.
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RECORD OF INSPECTIONS
Date Passed
FOUNDATIOK
House.