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BUILDING DIVISION Applicant Fill ZONE NUMBER 00005
9ERAAIT APPLICATION Inside Heavy Lines Oe iL5 IZ
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LEGAL DESCRIPTION 3U BDIV ISION
SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
[L[PHON[ NUMBER
774 mil.
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY
N
PUBLIC IMPROVEMENTS AfOUIREO
❑
Y
[
DRAINAGE IMPROVEMENTS REQUIRED
❑
1
TELEPMON[ NUMBER
DRAINAGE PLAN REQUIRED
❑
U
UNDERGROUND WIRING REQUIRED
❑
J
B
CONNECTION TO SANITARY SEWER
❑
7
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EPTIC TANK PERMIT REQ'D ❑ NO.
ELEVATION OF PROPERTY CORNERS
❑
h FOOTINGS REQ'D
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TCLEPHONE NUMBER
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SE[ ENGINEERING MEMO DATED�
I
ATE LICCHSK ` CITY LICENSE NUMBER CHECKED BY
peel Description of Property Show Below or Attach Four Copies)
METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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SIGN AREA ENV. REVIEW ADB NO.
AOWED PROPOSED COMPLET EXEMPT
LL
SHORELINE
REMARKS
VARIANCE OR CU PLANNING REVIEW BY OATS
YARDS LOT COVERAGE
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❑ NEW
RSSID[N TIAL
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SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
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REOUIREO GROUP-� LOAD
❑ YES ❑ NO
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❑FENCE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
❑
OF EDMONDS. LOCAL SALES TAX
REPAIR
PR[ -Move
❑ INSP.
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POOL
SHOULD BE CODED 31.04.
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REMARKS-Z'"7 T f�•II .M (lT C1L $(�Cfl
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UMBER OF STORIES
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NUMBER OF
LING
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UNITS
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ATURC OF WORK
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PLAN CHECK FEE VALUATION FCC
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n ' Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
Wi successors in interest, agrees to indemnify, defend and hold harmless 9i
Z the City of Edmonds, Washington, its officials, employees, and RETAINING wALL 0 `
0 7
E t from an an all U' s for derma es of whatever nature U
agen s y e c Im g.
i arising directly or indirectly from the Issuance of this permit. Issu-
SWIMMING POOL
O ante of this permit shall not be deemed to modify, waive or reduce
G any requirement of any city ordinance nor limit in any way the
x City's ability to enforce any ordinance provision."
I hereby acknowledge that 1 have read this application; that the in-
TOTAL AMOUNT DUE
formation given is Correct; and that 1 am the owner, or the duly author-
ized agent of the owner. 1 agree to comply with city and state laws regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
wi(Ibe employed in violation of the Labor Cade of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
NOTE- �1: ®ON YQW(Escept DEMOLITIONS and FILL
ONLY THE
PERMITS wit ut conditional use permit, which shall be completed in 90
WORK NOTED
t•- OV IN UILDINGS &hall be completed in six months.)
IQ R[ oW A EIIT
1
OAT[ SIGNED
INSPECTION
O[PA RTMCNT
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-
CITY OF
EDMONDS
Thla Permit Boars Brock to be done on private property ONLY.
Any eonstructlon on the pudic domain (curb, sidewalks, driveways,
775-2525
mer4ae�, em.) Will require aoperate 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 3G4, 306.
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APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and i
receipt is acknowledged in space pro- j
vided.
IR[CTOR'
AT[ 0
J
ORIGINAL - File YELLOW - Inspector
PINK - Owner GOLD - Assessor
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