810516.pdfs
CITY OF EDMONDS
U•a/:
.D"I
PERM1,
NUMBER
8 I C)S I h
BUILDING PERMIT APPLICATION
OR
{
IOR NAME OF BUSINESS)
ONAM[
!
R
C
LEGAL DESCRIPTION
9V DIVISION
fQjSjHORT SUB NO.
vtl {L/
I
r
t`..•, _.,_
♦
W MAILIN ADDRIC ^/l/
'� t/ ` L ` Ut a?s cC
` "u•
PUIILIC RIGHT
OF WAY PE14 Or FILIAL
STREET
MAP
CI Pw
ELEPHON9 NUMBER
(•`�"Lj
A
o V
1•II OI.OSEO
•
OEI IC IL'.NCV
OI" 1 4VI1 OF WAY
1
W 1/�'-J I/�_ --�—
W ADDRESS
CII I:CK tO IfV
I.(
SEE ENGINEERING
MLMO
DATED ,—
Z
U —
REMARKS
_
E CITY
<
TELEPHONE NUMBER
_ v`
l_ `•fL_,j\/_
E
0 ADDRESS
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
<
It CITY
TELEPHONE NUMBER
REMARKS
OI.
U STATE
LICE NUMBER
CITYLICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
Legal Description of Property (Show Below or Attach Four Copies)
VARIANCE OR CU PLANNING REVIEW By DATE
2
0
YARDS LOT COVERAGE
I
6
�
FgONT SIDE REAR
N
W
REMARKS
0
J
u
W
J
❑ NEW RESIDENTIAL ❑ PLUMBING
CHECKED BY TYP
OF CONSTRUCTION COOS
HEIGI
NON-RESIDENTIAL ❑ MECHANICAL
/
q 7
❑ ADD ❑ DEMOLISH ❑SIGN
SPECIAL INSPECTOR
REOUIREO
AREA
OCCUPANCY
GROUP
OCCUI
LOAD
ALTER EXCAVATE FENCE
❑ OR FILL ❑ (_ X_FT)
{�
❑ YES ❑ No
RE ARKS
REPAIR swim
n
COMPLIANC ES NSA. O POOL
C
Z NUMBER OF STORIES NUMBER OF
O DWELLING
F ITS
rc NATUR�F WORK Fn(ATT ACH PLOT PLAN)
VALUATION I FEE
s
/ i0 r
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any Construction an the public domain (curbs, sidewalks, driveways,
FENCE
marquess, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
Permit Limit: t Year -Provided Work Is Started Within 120 Days
RETAINING WALL
Applicant. ,it behalf of III, nr her sporl<e, ;11'i911\ and
SWIMMING POOL
W successors in Inlere'♦t, agreeti IU iltdlrnnil)', defend and hold It:ltittle♦♦
J
i the City of G(hnunds, 11'ashingtun, its officials, em Plovcn, :uxl
E agents front an)' and all claims for d;lln3fes of whatever nature,
n1l
a
x arising directly or indirectly from the iccuanee al Ihi♦ pennn. If♦u•
C son` oI This permit .hall not he deemed to In nnlifv, KaiVe or reduce
TOTAL AMOUNT DUE
JO :In)' retluirel ton III ail), cite ordinance nor limit in ,III\' \\a\' the
x I C'ity's abilil)' to enforce any ordinance pr ,loon."
ATTENTION
APPLICATION APPROVAL
�llt caln,ll' dial file III -
hereby' acknowledge that l ha- read IIII♦ . :II I
formation given I% e'llrre`ct; and that I aril the' ow'lle•1, rIf Zile dill)' allillor-
THIS PERMIT
This application is not a permit
iced agent Rt the o\\'tier. I agree III �,,it ply \with ell\' and ♦late lases rt•gu.
AUTHORIZES
until signed by tile' )llllldtllg` Official or
lating construction; and In doing the work allthorl/ed Ihetch)'. it,, rler♦ n
ONLY THE
his Deputy:Ind Ices are paid, and
willbe employed in violation of the Lahor Code of tileState ,fl 11 adlmglou
WORK NOTED
iecetpt Is ace tiow'ledf,Cd in space pro -
relating to Workmen's Compensation In♦manee.
tided.
SIGNATURE (OWNER OR AA^GENTI
GATE SIGNNIO
INSPECTION
DEPARTMENT
DIR TOH'S SIGNC,TURE
�% ✓i1 / L'l`GL.1.�
'�6
CITY OF
EDMONDS
DA
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS, LOCAL SALES TAX
775.2525
v
SHOULD BE CODED 31.04.
ATTENTION
ORIGINAL File YELLOW tt3pecmi
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK — Owner GOLD — Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 301i,
102-]9
O
. 1
i
I
it
r
1
RECORD OF INSPECTIONS
Date Passed
FOUNDATION
House
j
Porches. pies
Retaining walls
\`
Garage, carport
{ ��
PLUMBING
Underground
}�
Rough•in
i
Water service
I
i
t
HEATING SYSTEM
{
FRAMING
WALLBOARD --
{
FINAL —