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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NMAME OF USINESS
Al Vl'�
LING ADDRESS
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NUMBER
NAME
OF SS
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S�A�TIE LICENSE N14MBER
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Legal Description of Property - include all easements
OV,
USE
ZONE PERMIT
NUMBER
JOB
ADDRESS (0
NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCIP Approved
0
RW Permit Required
13
EXISTING —REQUIRED DEDICATION —
Street Use Permit Req'd
0
Inspection Required
0
PROPOSED
Sidewalk Required
0
Cr
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
W
F
YES 0 NO 1:1
REMARKS
Z
Ir
W
W
ENGINEERING
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EX
LOT COVERAGE
ALLOWED I PROPOSED
Ape # SHORELINE #
SIGN AREA HEIGHT
ALLOWED I PROPOSED ALLOWED I PROPOSED
QUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
Property
Tax Account 0. o
Parcel No. ILI '-I Ca I o
L
LOT AREA
I
PLANNING REVIEW BY
I
DATE
r7ly
NEW L-f-RESIDENTIAL LZI-PLUMBINGIMEC.li
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. SIGN
'E] GRADING FENCE
gREPAIR CYDS. L_ FT)
WOODSTOVE
DEMOLISH SWIM POOL
INSERT HOT TLIB/SPA
GARAGE RETAINING WALL/
c ROCKERY RENEWAL
REMARKS
CHECKED BY
TYP OF CONSTRUCTION
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m
OCCUPANT
GROUP
SPECIAL INSPECTOR
REQUIRED
0 YES
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
(TYPE OF USEPSIN_ESS A IVI Y)EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
INUMBER
L/
A 0
q I 61�/o
DESCRIBE WORK TO BE D9NIE,(ATTA 7HP L 0 T PLIM)
�UA J,a7VT /II,
FINAL I'NSPECTION REQUIRED
QLlAk 0 Ln-411
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
all
GLAZING
PLUMBING
60 —
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
E whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
:r
nor limit in any way the City's ability to *enforce any ordinance
provision."
TOTAL AMOUNT DUE
1
1.6
I hereby acknowledge that I have read this application; that the
I h
information given is correct; and that I am the owner, or the duly
I n f r
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
0 u
THIS PERMIT
state laws regulating construction; and in doing the work authoriz-
stat(
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
l'
ONLY THE
signed by the Building Official or his/her
Lah
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
.tion--Insurance aria RC.AWN-_4VB..2
INSPECTION
acknowledged in space provided.
SIGNATURE OWNER OR A DATE SIPNED
DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE DATE
EDMONDS
ATTIE TION
CALL FOR
'4LEiSL) BY DATE
INSPECTION
IT IS ' AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK — Owner GOLD — Assessor
102-97