820427.pdfN .
USE PERMIT qqe
i CITY OF EDMONDS r-DRESS
/�� NUMBER 82W27
CONSTRUCTION PERMIT APPLICATIONV ///NAME (OR NAME OF BUSINESSI
/ T7 i /1 //� „T. n ESCRIPTION CHECK SUVISION IDBDIN LNO I
CITY TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
_
e- rn.T /iG s �7, -1, y�
'67
EXISTING REOUIRED DEDICATION
1
NAME
PROPOSED O
N�
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
L ADDRESS
-
STREET USE PERMIT REQUIRED i
2
=
SEE ENGINEERING MEMO
i CITY TELEPHONE NUMBER
SEE PIW DEPT REVIEW CHECK LIST DATED
REMARKS
NAME
m ADDRESS
° 6
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
CITY / TELEPHONE NUMBER
r
O �4.6?" C;4, / / / /s
REMARKS
-S
O STATE LICENSE NUMBER CITY LICENSE NUMBER
'' 11 //V �� / `'
(,7TI GJ�v IL'G
N
/
�- hk -0 W `-x / o V /-
SIGN AREA ENV. REVIEW AO/
Legal Description of Property -Include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach fourcoples)
_1 IR sH°neuter
E /tf,6 N� 'M f�DD�
VARIANCE OR CU PLA REVIEW GATE
i
°
O C
YARDS LOT COVERAGE ?
N I^•
w (/ /^• J
FRONT SIDE REAR �� M 4
E ARKB S
i
f�f
❑ ®
NEW RESIDENTIAL PLUMBING
® ❑ ❑
ADOIALTER NON-RESIDENTIAL MECHANICAL
❑ ❑ ❑ SIGN
4
REPAIR RETAINING WALL
❑ DEMOLISH ❑ OR FILLTE ❑ ; ENCE K--�
CHECKED BY TYPE�i CONSTRUCTION CO J� HEI(iHT��
kq ZSS
I 1
❑ PRE -MOVE INSP.1 ❑ SWIM
POOL
SPECIAL INSPFCTOfl AREA OCCUPANCY OCCUPANT
GROUP
COMPLIANCE INSP.
REQUIRED r7 Z LOAD
"`•J
❑ SIDE SEWER ❑ WATER LINE ❑
I: YES I NO
REMARKS
t
T GC1 A.L- lw VL. 17F—(L 19 !�,Txm CAD
j
a El ❑ ❑
,
m
NUMBER OF STORIES NUMBEROF
,XL��EI�! 171-EL�r�1•�/7 �D
o DWELLING
t' I
m UNITS
O' NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
!)
VALUATION FEE
PLAN CHECK FEE 1
BUILDING ,000 10
PLUMBING
MECHANICAL
1
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
4
driveways, marquees, etc.) Will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work Is Started Within 180 Days
I '
"Applicant, on behalf of hi or her spouse, heirs, assigns and
- {
y Successors in Interest, agrees to Indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials.
I
m employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the Issuance
= of this permit. Issuance of this permit shall not be deemed to
i
9 modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the Clty's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE +
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
slate laws regulating construction; and In doing the work authoriz•
THIS PERMIT This application Is not a permit until
AUTHORIZES
4
ed thereby, no person will be employed In violation of the Labor
ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED Deputy; and fees are paid, and receipt Is
,
tion InsurWce.
INSPECTION acknowledged in space provided.
SIGN JTU �QWN O Ij� DAj�15/N (�
DEPARTMENT
OFFICIAL'S SIGNATURE
CITY OF
EDMONDS
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
ATTENTION SHOULD BE CODED 31.04.
775.2525 DATE
IU
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
PANCY HAS
A CERTIFICATE OF OCCUBEEN GRANTED,
r`
UBC 0CT1982
CHAPTER 3.
10278
PINK — Owner GOLD — Assessor
..•,., ,,, ,,,,.,,..,..
1 11, i
ZONEIs -
IS-,
SETBACKS:
FRONT
SIB:: __
FEAR
OTHER
HEIGHT
4
..
1 II
i
FRAMING -
WALLBOARD -
FINAL I