315 MAIN STCITY OF EDMONDS
FIRE PREVENTION
FILE MEMO/HAZARD FORM
DATE REPORTED BY
OF
SUBJECT
ADDRESS:
CONCERNS/
HAZARDS:
FOLLOW-UP:
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SIGNED
SIGNED
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CITY OF EDMONbs
USE PERMIT 02 '54
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NUMBER
CONSTRUCTION PERMIT APPLICATION
jos SUITE APT
ADDRESS
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OWNER NAME NAME OF BUSINESS
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L . EGAL DESCRIPTION CHECK
SUBDIViStON NO
LiD NO
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MAILING ADDRESS(
—TY—EL—EP—HONE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — REQUIRED DEDICATION
PROPOSED
TESCP Approved 0
RW Permit Required 0
Street Use Permit Req*d 0
Inspection Requ ired 0
Sidewalk Required 0
CITY ZIP
NUMBER
NAME
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W
0
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LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
ADDRESS
REMARKS
CITY Zl�___7PHONE
NUMBER
NAME/-,
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DRE55
lo 0 0
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0
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ENGINEERING MEMO DATED REVIEWEDBY
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
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Z
6 7 )_2
S TE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
C PLETE EXEMPT
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ADD NO-
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SH(;A�LINE 0
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Legal Description of Property - include all easements
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VARIANCE OR CU
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PLrII71t E_ BY
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SETBACKS - FEET
FRONT SIDE REj
HEIGHT
7ERAGE
Property
Tax Account
Parcel No. 0 a r. 60100
REMARKS
44 <
NEW RESIDENTIAL 0 PLUMBING
ADDIrION 2-COMMERCIAL 1:1 MECHANICAL
a.44)0 6Y) 0
Z
0
APT. BLDG.
REMODEL 1:1 11 SIGN
GRADING FENCE
REPAIR E] — CYDS. x _FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUB/SPA
GARAGE RETAINING WALL/
CARPORT ROCKERY RENEWAL
CHECKED BY
TYPE OF CONSTRUCTION
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CODE
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9
OCCUPANT
GRqPP
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SPECIAL INSPECTC
REQUIRED 0 YES
OCCUPANT
LOAD
PROGRESS INSPECTIONS PER USC 305
(TYPE BUSINESS OR ACTIVITY) EXPLAIN:
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0
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0
POSIE.
NUMBER
OF
STORIES
NU BER OF
DWELLING
UNITS 0
CRITICAL
AREAS
NUMBER P.)n
_/.1 /9
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewEilks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days .
STORM DRAINAGE FEE
ENG. INSPECTION FEE
,n
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors I n interest, agrees to indemnify, defend and hol
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harmless the City of Edmonds, Washington, its officials,
employees. and agents from any and all claims for damages of
whatever nature. arising directly or Indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
4
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I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ONLY THE signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor WORK NOTED Deputy; and fees are paid. and receipt is
Code of the State of Washington relating to Workmen's Compensa- acknowledged in space provided.
tion Insurance and RCW 18.27. INSPECTION
SIG TuRE (OWNER OR AGENT DATE SIGNED DEPARTMENT OFFICJA.!j�iGNATURE DATE
7i
CITY OF
EDMONDS
CALL FOR RELEASED BY DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ORIGINAL File YELLOW — inspector
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK GOLD — Assessor