820362.pdfa
CITY OF EDMONDS Z
ONE
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESSI '.QAVQE*M,X.^LGAL DESCRIPTION CHECKI SUBOWISION NO '
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING 1 REOUI IEDDEDICATION F,
PROPOSED &
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED _
SEE PIW DEPT REVIEW CHECK LIST DATED _
REMARKS
AI Y _7st,1-:_ �,
STATE
CITY
—151;��11!p4
INE NUMBER
PERMIT
NUMBER
3r rl3T.-T Gv
S12E IBUILOING SUPPLY SIZE
820.3
In 1 <. 0
i
r
SIGN AREA
ENV. REVIEW
ADB NO
ALLOWED
PROPOSED
COMPLETE
EXEMPT
/
R
SHORELINE N
DATE
VARIANCE OR CU
PLANHMG REVIEW
BY
YARD�S LOT COVERAGE IF
FRONT AO SIDE L� REAR 3 ./a,lw 7-5
NEW ® RESIDENTIAL
❑ PLUMBING
�❑}yy
Iml AOOIALTER ❑ NONRESIDENTIAL
❑ MECHANICAL
❑ REPAIR ❑ RETAINING WALL
❑ SIGN
EXCAVATE
❑ DEMOLISH ❑ OR FILL
FENCE
❑ (_x___FT)
CHECKED BY TYPE OF CONSTRUCTION
N
CODE
S9 r 1
HEM
PRE -MOVE INSPJ
COMPLIANCE INSP.
❑ SIDE SEWER ❑ WATER LINE
SWIM
POOL
❑
SPECIAL INSPECTOR
REOYESEO NO
REMARKS
AREA
OCCUPANCY
GROUP �-Z
•J
OCCU
LOAD
❑ ❑
❑
L
f� stz
9 0
NUMBER OF STORIES NUMBEROF
2 DWELLING
UNITS
J
l
PROG116
(
EQD
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
PLAN CHECK FEE
BUILDING
Z�
J
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRAOINGIFILL
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 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
H successors in Interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
I 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
DO nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
[.
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 authoriz• AUTHORIZES
This application Is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE
signed by the Building Official or his
Code oft a ate of Washington relating to Workmen's Compensa• WORK NOTED
Deputy; and fees are paid, and receipt is
tl n In n INSPECTION
acknowledged In space provided.
SIG UG/ DF.PARTMENf
z_
`6�c/! 3�e
CITY OF
OFFICI L'S SIGNATURE
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX 775.2525
ATTENTION SHOULD BE CODED 31.04.
DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
i�J
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR �j 1/.� I �--
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
102 78
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