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USE PERMIT
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CITY OF EDMONDS 840iluu,� n I
CONSTRUCTION PERMIT APPLICATION JO5
NAME fOP NAME OF BUSINESS) ADDRESS 1 q O 'o • q x ±
.hl�l Fh L. JD �.• 17`1U A(f Sl', LEGAL DESCRIPTION CHECK SUBDIVISION N LIT NO. � -'
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CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL ETREEI MAP. ! !
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PROPOSED '!
NAME U,
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED w
ADDRESS STREET USE PERMIT REQUIRED Z
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SEE ENGINEERING ME:!O DATFD ._ _ W t
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Gil TEI_E PHONE NUMBER SEE. PIW DEPT. RFVIEV! CHECK LIST DATED - „I
REMARKS
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ADDRESS G 01 11r- • C!-Y// ri
O G hi E SIZE BUILD -. ::ICE FIXTURE UNITS ~
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CITY TELEPHONE FUh54R ;
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REMARKS
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4 STATE. LICENSE NUMBER — CriY LICF NSF NUMBER
SIGN AREA FaJV. REViF:W ADB NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXENIPT
(show below or attach four copies) SHOHFUNE
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g VARIANCE OR CU PLANNING REVIEW BY --_- DATE
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REPAIR RETAINING WALL SIGN
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DEMOLISH OR FILE i _ x _. FT] (,
PRE MOVE INSPSWIM SPECIAL;NSPECTOEI TAREA O
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COMPLIANCE ItJSP POOL REQUIRED GROUP LOAD
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NATURE CIE VvORK TC 5E DONE IATTACH PLOTPLANi i� f
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s _ ! t.0CD ` V=. L'JATION FEE
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This Pere .ere tvork to be done or: private property ONLY 6
Any s? .;,:,_'r on the public domain tcuros, sidewalks
Wni 'e qU'r:� Sepzrate rermission.
i'r-.!...,�.:Lo.:s: "O Days --
Pe: Mi Limit: 1 Year Prwlaed V%York is Started W!tnin ?b0 Davs
n oeha1f of his or her spouse. neirs. assigns and
xassers In interest. agrees to indemnify. defend and held
harmless ifT e. Ccy In' Edmonds. V�asn ng(On. t?s Officials.
employees. anC aGents from any and ail Claims tot damages of
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t:hatL vt r nattJ c aris.ng d!rectl\ or indirectil 'rJrn ;rie Issuance
Of this pernTi, 'p_JanCe OS ?h:s .erfP.l? Sna: n ? Ce deem2C IU (.ICFTT f (; LIT
O moOr'� Y31A'B L)r 'ejJ.;ac e rrecuitemen' o- wo C t`. Ordinance -
noi I! ,It m an.%a% tre CI;','s abititi. .o < 'orre a-T. ordinance I.
TC`AL arY{OUNT DUE
provlsiOn.' F EES WA1:yC T> I
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I hereby ackr,ct%!edge tnat I 'la.e feaci thI 3;:Dhca?lOn: that the
information given is CCrre-t, and that 1 <trTT " e �sner. Cr the duly .LLTTENTION APPLICATION APPROVAL i
aUtncrl�e.i age `i ,f the fler. I agree ?O comply with city and ;
State latte reau:a,itry CDnS,r UCiion. and in cc,ng (ne NOCk aUthOTI� -L This application Is not a permit until a '
ed thereoy, ro Dersen ;,ill be emDic}ed I o'atlon of The Labor signed by the Building Official or his j
Code ct the Star 1':asr, Ington resting ?o',:'orK:r.en's Compensa- °^ " =- Deputy; and fees are paid, and receipt is �p
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�`,- rc>: acknowledged in space provided.
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EDMONDS
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ATTENTION ''' J`"` DAtF
IT IS UNLA'.: VL TO !SE OF. OCCUPY y 3L".'-DII:G C'R STRLICTU,RE u� --
1JNTI1 A FI?.AL II zt-E TIOP+ S 5EI= N '.tADE A'JD APPROVAL OR ORIGINAL — File YELLOW — Inspector _ 't
4 CEF" I, ICATE 0 F OC .'L1PA%CY A S E 2 GRANTED, U80 f
Cr4 TER APR 3 I(�Ovt PINK — Owner GOLD — Assessor
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