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CITY OF EDMONDS 20NE NUMBER O I0423
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BUILDING PERMIT APPLICATION
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,�Z_ LEGAL OESCRI TION SUBDIVISION
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ELEPHONE NUMBER
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PROPOSED
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DEFICIENCY OF RIGHT OF WAY
CHECKED BY
ADDRESS SEE ENGINEERING MEMO OgTEO
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CITY TELEPHONE NUMBER REMARKS
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NAME
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METER 512E BUILDING SUPPLY 512E FIXTU RE UNITS
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REMARKS
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CITY TELEPHONE NUMBER
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S AT LIC S U R CITY LICENSE NUMBER SIGN AREA ENV. REVIEW ADO NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE #
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Legal Description of Property (Show Below or Attach our Copies)
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VARIANCE OR CU PLANNING REVIEW BY DATE
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YARDS LOT COVERAGE
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FRONT SIDE REAR
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REMARKS
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❑ NEW RESIDENTIAL PLUMBING CHECKED BY TYPE OF CONSTRUCTION COijDEr HEIGHT
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❑ N ON•RESIDENTIAL MECHANICAL '�E t�( 1 ,
ElADD ICI DEMOLISH ❑ SIGN SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
J REQUIRED GROUP 2 LOAD
❑ ALTER ❑ ORCFILLTE ❑ i ENCE X_FTI R MARKS YES ❑ NO 7
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❑ REPAIR
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COMP CESNSP. POOL
= NUMBER OF STORIES NUMBER OF 1 •T���11
DWELLING 1-(
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i NATURE OFWORKTO BE DONE (ATTACH PLOT PLAN)
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PLAN CHECK FEE
VALUATION FEE
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BUILDING
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PLUMBING
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MECHANICAL
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This Permit covers work to be done on pr'vats property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FENCE
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marquees, etc.) will require "parsto permission.
SIGN
Permit Application: 180 Days
Permit Limit: i Year- Provided Work Is Started Within 120 Days
RETAINING WALL
N "applicant, t,I, behalf of his or her spline. [,,I,, a%,I-n, and SWIMMING POOL
W sucecssl+rs in intere%l, uyrces it) indemnity. defend and hold IF less
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F the City of F.dlllo lids, 11 a0tington, its otficials, empit'yecl, and
C agent) front all)' and all e'laint, It', doll agl'1 Ili Whatever nature.
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Q . Is""�„1n
x arising directly or indirectly front the issuance of this
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D :mce of this permit %h.11 nor he JeenK•d I,,modify, wake or reduce
TOTAL AMOUNT DUE
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J any reyuirenK•nt ai any cip' ordinance nor linlii in any uay the
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x C'iq's ability to enli+rce any ordinance prurlsinn.'
ATTENTION
APPLICATION APPROVAL
I hereby acknowledge that I have read this applicallnn; ilia, the Ill -
THIS PERMIT
This t 1liCatiOn Is $lot '1 l'tiilit
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formalion given 1% correct; alld that I alll the owner, tit the door aathor•
AUTHORIZES
1111111 signet' h file Building Official lit
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11ed agent of IhC oN'net. l agtl•L• to follllll)' N'll )1 ell)' and dale i:l %t'} It'gll-
ONLY THE
his Deputy; and fees are paid, aild
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lating construction; and in dt,ing the %fork aallimued thereby, no pertsun
lithe employed in violation t'l the Lahur Code of tileSkiff of Wa%hingion
WORK NOTED
reccipi is acknowledged ill silace 11r11-
relatmg It' Workinell s Coulpelisalit'll In%Ilrance.
INSPECTION
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DIRECT R'5 SIGNATURE
SIG ,E IpWNERO(�R AQ_ENTI DATE SIGNED DEPARTMENT
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CITY OF
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DATE
EDMONDS
T IS SITE IS LOCATED IN THE CITY
775.2525
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OF EDMONDS. LOCAL SALES TAX
ORIGINAL - Fdr YELLOW 111111,0111
SHOULD BE CODED 31.04.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK — Owou, GOLD — Assesso,
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
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APPp-d4av F•0(2- iUsi Ali-�Ti'�
RECORD OF INSPECTIONS
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Date Passed
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FOUNDATION —••- —
House
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Porches, piers-----------
Retainin
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Game. cn;ao•t
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PLUMBING
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Water service ------- — .......... .. ..._...._....
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Alt{I�r,�}YLT1a EN51�N A5
HEATING SYSTEM
RE4\)'\J1W/Sc' Y'I $l-Df� NSPSC-Tu�-•
FRAMING _-------- __....-- -
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WALLBOARD
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FINAL
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