800203.pdfBUILDING DIVISION
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Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
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NAME (OR NAM[ OF ■USIN[SSi
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LEGAL DES IPTION SU BOIVISION SHORT SUB NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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DRAINAGE IMPROVEMENTS REQUIRE. ❑
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CITY TELEPHONE NUMBER
DRAINAGE PLAN REQUIRED ❑
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Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE BVILDING SUPPLY SIZE
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REMARKS
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SIGN AREA ENV. REVIEW ADS NO.
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VARIANCE OR CU PLANNING REVIEW BY DATE
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
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OF SHOULD. BES. LOCAL CODED 31.04. ES TAX
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BUILDING 805
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N 'Applicant, on behalf of his or her spouse, heirs, assigns and
SIGN =__ _ 3
Wi successors in interest, agrees to indemnify• defend and hold harmless
f the City of Edmonds, Washington. its officials, employees, and
RETAINING WALL
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[ all claims for damages of whatever nouue,
agents from any and
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x arising directly or indirectly from the issuance of this permit. Issu•
SWIMMING POOL
Q ante of this permit shall not be deemed to modify, waive or reduce
J any requirement of any city ordinance nor limit in any way the
= 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 I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be 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 Limit One ieOr(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 he completed in six months.)
Bided.
SIG TU [ (OWNER OR GENT) DAT[ SIGNED
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INSPECTION
OEPAgTME" OIR CTOR'S SIGNATURE
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RE CIT}Y�OF 'Al �L4e�-
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This Permit eovere o done on private property ONLY.
775-25Z5
Any eonatructlon on pu domain (eurbs, sidewalks, driveways,
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morqucan, .I will require separate parminion.
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ATTENTION �
'�^r 13 'an ORIGINAL — Filu YELLOW — Inspector
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
FINAL HAS BEEN MADE AND APPROVAL OR
Clfy PINK — DWI,,., GOLD — Assessor
OF
UNTIL A INSPECTION
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A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 3DG.
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POS.
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ADI-DMON
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PI-OT P LA�A
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FOU N DATIOR
House
Porches, piers
Retaining walls
Garage, carport
PLUMBING
Underground
Rough -in
Water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL