790109 (2).pdfBUILDING DEPARTMENT Applicant Fill
USE PERMIT
ZONE NUMBER 790109
901py
PERMIT APPLICATION
Inside Heavy Lines
NAME JOR NAME OF BUSINESS)
ADDRESS PL.
LEGAL LOT PLAT NAME SUB DJIVISION Ni
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YES INO
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RIGHT OF WAY PER ORDINANCE NO.
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CITY
ELEPHONE NUMBER
PUBLIC
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!%IST ING RIGHT OF WAY
RIGHT OF WAY
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PH OPOSED
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DEFICIENCY OF RIGHT OF WAY C)
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STREET/UTILITY WORK REQUIRED EYES ❑NO
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PERMIT FOR WORN IN PUBLIC R/W CY YES ONO
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TELEPHONE NUMBER
UNDERGROUND WIRING REQUIRED KNO
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11❑OO��Y""ES
CONNECTION TO SANITARY SEWER AYES
NAME
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I❑ENO
SEPTIC TANK PERMIT REQUIRED /❑�Y ES qNO
SEPTIC TANK PERMIT NO.
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SEE MEMO DATED
Q CITY
Q icy �I�/
TE LEPJH OcNE NUMBER
REMARKS M
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U ar Arr t Irc NCE NUM wEw
CITY LICENSE NUMBER
CHECKED BY 1\ rl \ t
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SIGN AREA ENV. REVIEW ADB N
1 ALLOWED PROPOSED COM PLET1 E _— ,N rfl1 SHORELII
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REMARKS
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VARIANCE OR CVBe
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NON-RESIDENTIAL
❑SIGN
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ADD
❑
DEMOLISH
RETAINING
SPECIAL INSPECTOR
REQUIRED
AgEA
WALL
❑ YES ❑ NO
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❑
ALTER
a
EXCAVATE
OR FILL
FENCE
❑ i_ X Fr)
PLAN CHECKED BY
]HIE
❑
REPAIR
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PRE -MOVE
INSP.
SWIMOF
POOL
SH O'
E OF
REMARKS
REVIEW BY DATE
LOT COVERAGE
REAR O�
r CODE HEIGHI
CCUPANCY OCCUPA
iOUP-I LARD
PA-3
BE
NUMBER OF STORIES NUMB R
ZO {1 DWELLING UNITS t-}1FRMAL NSULATiollA PERR. Fib
1-p��
G NATURE OF WORK TO BE DONE
Ld� DRAIIJAC� 1 R CRD 1i14 OL G
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O PLAN CHECK FEE VALUATION FEE
PROPOSED USE
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PLOT PLAN INDICATE BUILDING SETBACKS, AAe?
2 ABUTTING STREETS)
BUILDING
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PLUMBING
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MECHANICAL
FENCE
SIGN
Iwn "Applicant, on bellall of his, Or her sp(Inw. heirs, assigns and
W successors in interest. agrees to indemnify, defend and hold harmless
-I
i the City of Edmunds, Washington, its officials, employees, and
RETAINING WALL
Q agents from any and Ill claims for damages of whatever nature,
Q
x arising dircrtfy or indirectly from the issuance Of this permit. Issu-
SWIMMING POOL
a :nce of this permit shall not be deemed to modify. waive ur reduce
J any requirement of any city ordinance nor limit in any way the
Cupp *(Is
= City's ability to enforce any urdinmlce provision."
1 hereby acknowledge that I have read this application; that the in-
TOTAL AMOUNT DUE
formation given is correct; and that 1 ant the owner, or the duly author-
ized agent of the owner, 1 agree to conlplY with city and state laws regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the Slate of Washington
THIS PERMIT
relating to Workmen's C'ompensatio j Insurance.
AUTHORIZES
NOTE: Permit Limit One Year(Except DEMOLITIONS and DILL
ONLY THE
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED
MOVED-INUILDINGS shall he completed in six months.)
R CR7 AG�E I
TE SIGNED
INSPECTION
DEPARTMENT
f�Lt%-Y��
LLL
-,� 7
CITY OF
EDMONDS
This Permit coven work to be done on private
property ONLY.
775-2525
Any Construction an the public domain (curbs, sidewalks, driveways,
marquee$, SIC-) Will require separate permission.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
1a2-/a
3
# 41 A0 3oa
511'
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro.
vided.
DIRECT 'S SIGN VR
GATE
ORIGINAL - File YELLOW -- Inspector
PINK - Owner GOLD - Assessor
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1
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ENGINEERING REQUIREMENTS F011 BUILDING PERMIT APPLICATION
CITY Uh' KIUJPIUS T
PUBLIC WMKS Di*-TAMME'NT 790109"
FT1, ,11 IEER.111t., m-V I 1011
SUBJECT: _
Subdivision
Multiple
DATE : j ng - 1
.Plat
Cori rr>L rc i a 1
G U IERAL RL qj IREI''IugTS
Coordination of the location or anv structure with respect to utilities, streets, property
lines and drivewtly grades is the responsibility of the contractor.
The ccnstraci-or is required to keep the abutting street cleaned of dirt and debris caused
by the construction 7.30.20E Violations - Penalties 7.30.290.
j 0 A "Right -Of -Way Construction Permit" is required from the Engineering Division of Public
Works for any work within the Public right-of-way or public Penalties 7easement. 7.30.010 Violations
hN .30.290.
SPECIFIC REQUIRU7jDrS
UNDERGROUND'POWER
❑
Underground Wiring Req'd VN Not Req'd
SANITARY SEl•IER (PER:•IIT RE01 D )
Connection to Sanitary Sewer Req'd
❑ Back Water Valve Req'd Side
❑
Septic Tank Pei-mit Read. Design Approval
on Sewer
Req'd
Approved Dt.
Permit Number
STORM SEI-E-R SYSTEM (PER CITY CODE
)
❑
Drainage Plan Req'd
❑ Drainage Plan Approved Dt.
❑
Site Drainage to be Contained on Site
Site Drainage to be Connected to City System
ROADWAY Ii•1PROVF•1L1TPS AND DRIV11•IAY RIEcIUIRSIEN1rS
Driv ,,ay Slone Not to Exceed 1
Driveway Faving Req'd
❑ Driveway Culvert Req'd Size
❑
❑
Vertical Curb Req'd
❑ Sidewalle Req'd
Street Paving, Req'd
❑ Approved Desig;n Req'd
❑ Bond Req'd for Public Improvements []Submit Cost Estimate
Note: �X►ST1.►��
Engi nc-el•in;r Ui vi si or.
Foundation Side Sewer ❑ Septic Tank
Water Service ❑ Fire Protection X Drainage
Site Trrprovem.�nts
A 24 - hour, notice is requ.iifd for inspection Engineering, call 775-2525, extension 220.
—�E % leDoeF=-
1 REII F. M-RZBERG, P.E.
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