840369.pdfUSE
CITY OF EDMONDS ZONE NUhBIEfif�,.3
CONSTRUCTION PERMIT APPLICATION JOe
NAI,EdOR NAME OFUSINE.SSi ADDRESS
1 , �{7 v !!Mq,
1` / L„_LEAL DESCRIPTIK St16 IVISIOrd .'JO. LID NO
w MAILING ADDRESS
o ISC'�I�I N$r''l, Uu.
TELEPHONE NUMBER PUBLIC RIGHT OF WA'i PER OFFICIAL STREET MAP.
1,�:4?L>rT✓L,7�] %Y 3"1.�E-" C/ EXISTING__._.. REOUIREDDEDICAT'ION
NAME
PROPOSED_...
- - �
Z
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED w
w ADDRESS STREET USE PERMIT REQUIRED w
u SEE ENGINEERING MEMO DATED `w
a Cir'f - TELEPHONE NUMBER SEE PIW DEPT REVIEY: CHECF LIST DATED
"M Fur y
NAME
e A D DILIF.SS
r METER SIZE �Ei i!!'_iu:.�: ~. -'_�' `.+G:E FIXTURE UNITS
U
= CITY TELEPHONE NUMBER
w
O REMARKS
C' STAY LICFNSE .'IUhfBER CITY LICENSE NUMBER
I, AREA ENV REVIEW ADB NO
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property -include all easements
(Sf1OVJ below or attach four copies) SHORELINE q
O
c
VARIANCE OP CU PLANNING REVIII BY _ pq
U r 1`
YARDS LOT CDVFRA;F.
7
w FNOP:T SIDE itEAfi
REMARKS
RESIDENTIAL F1 PLUMBING
1'jfd' �r
7
�L—J�j ADD,4:LTER NONRESIUEN i1nL
�J REPAIR U RETAINING liII SIGN
E"CAVATE FENCE CHECKED D'' II pI O( 0-;JT('1l'.`IOh ''Oi;E nFIGHi
l_J DEMOLISH1�,1 OF IL_ !. _I,.. FT)
PREMOVE INSP.; ❑ SWIM SPECIAL INSPEC,70R AREA OCCUPANCY IOCCII Pi.lJ'i
L! COMPLIANCE IJSP. POOL REQUIRED Gr=OUP LOAD
--, YES fV0
L�J SIDE SEWER D, VIATER LINE El REYAR^ 3 _--_--
U n ALL. GV{ At>iNL c 1=1t_._ ti'E.ffL U.C7c 70 o
u:NUtd RE.^i OF STORIES NUKIRFR OF i^\�G� 1 IO N7
o t`.Ve'_LINL, m
UYI:J
NATURE CP V.ORK TC,'. BE DOIJ_ IA'TT A;:+•, PLOT P,.%•'L
FILL (,Lj/77f
--.:/LC. 2/1(?�.6LU::TION FEE
li U ' /1•
aulLc::,G
-
I
This Pe,rn.t covers Wcrk't•o be done on private prooery ONLY. G24CL`.G FIB__
An', ;.e„est'uc .. on !ne public domain (curbs. sidewalks.
;:rive.va;s, r7).jrrIueeS •=tc ?wit! require separate oermissiol;.
oe Apphcaho^.180 Days --
P-erII It L!fnit'. T Yea' Pr,),, ided 1;cr'; Is Sttartea YJithin i80 Days
_ I
I .. !Ca:InIt. Or, Dehalf Of his or her spouse. reirs. assigns and
Tsars in I 71IIzreSt, agrees to indemnl`v deTand and hots I
tarmless the Ci.% c; Eamoncs. ':".'asmngton, its officials,
J
_ empiCyees. and agents ffcm anV and all claim; ;Cr ^. a.TdCes Of
or inG;rectl`froTlTaie 'T nature. �t rissuance
Of tn!s permit. ISSuanC? J't mis :e'rnit shail "_T L' ]eamad t0
'T100ifs. A3!Ve Or 'educe inv requtrem-n! ut in,.
_ Oralnd❑Ce
nor r r, !n an,; .%a, tha C !, S a^iitty I•c er'orcc an, orcilnanOc
provl5i _l❑... TO -AL AAO'JNT DUE
I hereby ackno:1,ledge that I have read ;nis application: that the Y
information Given. Is correct• ano tnat I am the cwne', or the duly TTENT 10", APPLICATION APPROVAL
authori:ea acer:t of the Owner, I agree to comply with city and
state laws regulating Construction: and in doing the :vofk authoriZ This application is not a permit until
Ed thefebc, no Corson .I I be employea in vioiation o! the Labor E signed by the Building Official or his
Code a; tha State of ',Ya shincton relaune To IVor'Kmen's Cornpensa- E Deputy: and fees are paid, and receipt is
(ion 41suI0-'l C acknowledged in space provided.
•A'C ! O- + `9 '... _ - - L 1 Y OP OFrIC!,L's SIGNATURE
Vi..l-s....
�j- aAC?et A1
ATTENTION "' ;`°°-TE
iT IS UPJLAI:=UL 'O JSE ..7R OCC' PNf 4 Ec DI ,G OR STRUCTURE
tNTIL 4 F;NAL INSPECT., N HAS % MADP,D APPROVAL OR ORIGINAL — Pile YELLOW — Inspector
Z;ERTIFICATE O� OC_UP.�NCt SAS =E^-i GRNTED_ tI r.
PINK — Owner GOLD — Assessor
i
t
r
,
1
:
:
r
�
j
I
i
i
!
'r
r
1
i
i
l
I
'
1
I
1
i
1
i
i.
f
l
1
i
i
i
i
1
i
i
I
+
4
I
y
f,
,
�I
!
l`_
J
(r
ENVIRONMENTAL CHECKLIST
A. BACKGROUND
1. Name of Proponent V w A.
2. Address and Phone Number of Proponent
3. Date Checklist Submitted 5 =/ q'� 9
4.
5.
6. Nature and briet Uescription of Proposal (including but not limited to
its size, general design elements, and other factors that will give an
accurate understanding of its scope and nture:
,CI L C.. P. P7` R,'044 1= ; t�� r✓ �fiL �'C"c x-a 2 71`TFC:%
o Z,. ,7 5 � Pt t,,).
7..Location of Proposal (describe the physical setting of the proposal, as
well as the extent of the land area affected by any environmental im-
pacts, including any other information needed to give an accurate under-
standing of the environmental setting of the proposal):
8. Estimated Date for Completion of the Proposal % S
9. List of all Permits, Licenses, or Government Approvals Required for.all
Proposal (federal, state, and local — including rezones):
10. Do you have any plans for future additions, expansions, or further
activity related to or connected with this proposal? If yes, explain.
I lb
11. Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain.
12. Attach any other application form that has been completed regarding the
proposal; if none has been completed, but is expected to be, filed at
some future date, describe the nature of such application form:
� I
-1-
`i i
rc
y'