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USE PERMIT
CITY OF EDMONDS ZONE NUMBER 300881
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[C70rNSITRUCTION PERMIT APPLICA7 ljoe 1 SUITEIAPT #
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0 0 ADDRESS
WINER NAME/NAME OF ?BTSINESS
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MAILING ADDRESS
11-2,0 /1-.
CITY
t�QAM
NAME
CITY
NAME
ADDRESS
CITY
STATE LICENSE
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TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
P/00 EXISTING REQUIRED DEDICATION
TELEPHONE NUMBER
NUMBER
Legal Description of Property - include all easements
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Tax Account Parcel No. 6 1 q
60 -_00 _620"I
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0 RESIDENTIAL
PLUMBING
ADDIALTER
El COMMERCIAL
MECHANICAL
REPAIR
11
APT. BLDG.
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DEMOLISH
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CARPORT
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INSERT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED El
SEE ENGINEERING MEMO DATED
SIZE IBUILDIN
REMARKS
SIGN AREA
ALLOWED i PROPOSED
VARIANCE OR CU
UNITS
ENV. REVIEW
COMPLETE I EXEMPT
NING REVIEW BY I DATE
SET13ACKS — FEET HEIGHT I LOT COVERAGE
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CHECKED BY ]TYPE
OF CONSTRUCTION
CODE
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REQUIRED
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OCCUPANCY
GROUP C,,-3
ElRENEWAL
REMARKS
PROGRESS INSPECTIONS PER
UBC 305
(V\.)(, F/+-M I L_V 6 to L�IL� /4j 6
NUMBER OF STORIES MBER OF
DWELLING
UNITS
NU
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
E FINAL INSPECTION REQUIRED
ft= VALUATION
10A r—
PLAN CHECK FEE
PL/V& BUILDING
PLUMBING 67
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Worl� is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
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
cc whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
_j modify, waive or reduce any requirement of any city ordinance
0 nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT UE
provision."
I hereby acknowledge that I have read this applicatio7that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
INSPECTION
DEPARTMENT
SIGNATURFAUWNER OR AGENT)
DATE SI N D
6-�D CITY OF
/12 -
2(a EDMONDS
CALL FOR
ATTENTION INSPECTION
11 IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
N CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
"',*PTER 3,
FEE
1-7-Tio
HEIGHT
OCCUPANT
LOAD
(3-5
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 provided.
RE DATE
10
IRELEASED By;
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ORIGINAL — File YELLOW — Inspector LI
PINK — Owner GOLD — Assessor / ZI
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CITY OF EDMONDS
-3202
250 -5TH AVE. N. e EDMONDS, WA 98020 * (206) 771
COMMUNITY SERVICES: and Recreation Engineering
Public Works e Planning e Parks
8 9 0 . I C�
LETTER OF TRANSMITTAL
Date:
To: 5T6L)EtNf F'P_E/,(C44
Plan review number:
Project: A
Address:
plans & Calcs_ Soils Report Other
LARRY S. NAUGHTEN
MAYOR
PETER E, HAHN
DIRECTOR
ranbill L HE,*
Comments:
For your information:
w1j'j, jFKP1l0C 6) 119, Gy
As requested by your office:
-rf+):s 0,�T-F_j 'YO14 5WUL'o
For structural plan review:
For non -Structural plan review:
For Wa I shington State Energy Code review:
\10ut PELP
For Northwest Energy Code review:
For Fire Code review:
Note attached comments:
For Corrections and resubmittal:
Building Division
Respond to letter in writing:
Resubmit 2 revised plans:
City Official
Send directly to City Building Division:
e incorporated August 11, 1890
Sister Cities International
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CITY OF EDMONDS
250 - 5TH AVE. N. @ EDMONDS, WA 1 98020 0 (206) 771-3202
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COMMUNITY SERVICES:
Public Works - Planning e Parks and Recreation Engineering
LARRY S. NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
9 0
LETTER OF TRANSMITTAL
Date:
To:
Plan review number:
Project: JJDAI
Address:// 2V A A
Other
Transmitting: � Plans & Caics— soils Report
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Comments:
our information:
For y
As requested by your office:
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efFor structural plan review:
al plan review: zeo�
For non-structur
cdlalul -Ovk a;4,
For Washington State Energy Code review:
For Northwest Energy Code review:
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For Fire Code review:
Note attached comments:
For Corrections and resubmittal:
Respond to letter in writing:
Resubmit 2 revised plans:
Send directly to City Building Division: —
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