820286.pdfUSE
CITY OF EDMONDS ZONE rl-5 - ()
ONSTRUCTION PERMIT APPLICATION ,OB
(OR NAME OF BUSINESS)LEGAL DESCII�N C1
[?NAME
MAILING ADDRESS ss t
PERMIT
NUMBER 820286
CITY TELEPHONE NUMBER PU RLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Y " EXISTING REQUIRED DEDICATION
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'ATE LICENSE NUMBER I CITY LICENSE NL
Bgal Description of Property • include all easements
how below or attach four copies)
L o-V 7_ : 1-1l \,N
L NEW
l'� 1 RESIDENTIAL
I� PLUMBING
® ADDIALTER
NON-RESIDENTIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
EXCAVADEMOLISH
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OR FILLTE
(ENCE_x_FT)
NSPJ
COMPLOIANCE INSP.
POOL _
SIDE SEWER
WATER LINE
NUMBER OF STORIES
NUMEIEROF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH
PLOTPLAN)
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED.____.
SLE PIW DEPT REVIEW CHECK LIST DATED
REMARKS
SUPPLY SIZE
SIGN
AREA
ENV. REVIEW
AD/B NO.
ALLOWED
PR OPOSED
COMPLETE
EXEMPT
/
SHORE/LINE/
N /�=
VARIANCE OR CU
PLANNING REVIEW
BY
DATE
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lei FRONT
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COVERAGE ?
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PECIAL INSPECTOR AREA OCCUPANCY I OCCUPANT
EOUIRED GROUP —? LOAD
YES NO J
EEnMARKS
T It� L7 � ASS t N G7YL�C.-� �Of+IJ K'C.�t�
\ _ �)_l•,_ VALUATION FEE
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PLAN CHECK FEE
BUILDING
CT -\<„ PLUMBING
MECHANICAL /
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work Is Started Within 160 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
N successors in interest, agrees to Indemnify, defend and hold
W harmless the City of Edmonds, Washington, Its officials,
!9 employees, and agents from any and all claims for damages of
< whatever nature, arising directly or Indirectly from the Issuance
o 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 TOTAL AMOUNT DUE
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provision."
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I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work aulhoriz-
ALITHDRIZEs
This application is not a permit until
ad thereby. no person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his
Code of the Slate of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy: and fees are paid, and receipt is
tl n Insurance.
INSPECTION
acknowledged in space provided.
SIGNATURE I�WNER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE
EDMONDS
�a,c e.-Q ^ , ki-+
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
ATTENTION SHOULD BE CODED 31.04.
775.2525
7 (q /E-1 2-
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
- PINK — Owner GOLD — Assessor
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Expired Permit Status Form
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Name:
5
Address:
Permit #
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Please check most appropriate box:
My work is ready for a final inspection. I will call the
Building Division at 771-3202 to schedule for an inspection.
_ I have abandoned my project and do not intend to complete the z
work my permit covered.
_ I will renew my permit within 10 days for a fee. f
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4.
_ Other, please specify. s }
Please fold this form, use our enclosed mailing label, stamp and
return to:
City of Edmonds
Building Division
250 Bell Street j
Edmonds, WA 98020
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