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830065.pdf- USy PERMIT"" CITY OF EDMONDS ZONE NUMBER 830065 j CONSTRUCTION PERMIT APPLICATION JOB \\ ADDRESS / ' 0 NAME IOR NAME OF BUSINESSI LEGAL DESCRIPTION CHECKI SUBDIVISION NO. I ILID NO. CITY.,,/ TELEPHONE NUMBER r;� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. REQUIRED DEDICATION.___ y7 1 �' 7 y �+ EXISTING .. .._ _ .....__.. PROPOSED _.__._ I J / J, '..NAM ! Z I w j •�: ..� a �.� C r y •�!•r RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ADDRESS STREET USE PERMIT REQUIRED I' i SEE ENGINEERING MEMO DATED w 1 CITY TELEPHONE NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED REMARK.-p!p� � {t9,��' NAME i'"'•� ADDRESS METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS CITY TELEPHONE NUMBER REMARKS a 3 J STATE LICENSE NUMBER CITY LICENSE NUMBER I 7 SIGN AREA ENV. REVIEW ADB NO. EM - ALLOWED PROPOSED COMPLETE EXT Legal Description of Property • include all easements 1 (show below or attach four copies) SHORELINE p VARIANCE OR CU PLANNING REVIEW DATE YARDS LOT COVEflAGE Z Z FRONT SIOE REAR � gI REMARKS ❑ ❑ ❑ PLUMBING NEW RESIDENTIAL I. ❑ ❑ ❑ ©� ADDIALTER NON-RESIDENTIAL MECHANICAL ❑ ❑ ❑ SIGN REPAIR RETAINING WALL EXCAVATE FENCE ❑ DEMOLISH LTA' OR FILL ❑ I x-FT) CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT I I % 7q ❑PRE -MOVE INSP.1 ❑ SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT COMPLIANCE INSP. POOL REQUIRED GROUP LOAD ❑ ❑ WATER ❑ I )YES I'. NO REMARKS4. SIDE SEWER LINE 1 w NUMBER OF STORIES NUMBER OF mI•. p DWELLING m UNITS NATURE OF WORK TO BE DONE (ATTAC PLOTPLAN) + � (f� VALUATION FEE i / PLAN CHECK FEE �.yt(�fP✓ Qr... "" • • BUILDING PLUMBING�.� 1. This Permit covers work to be done on private property ONLY. MECHANICAL GRADINGIFILL i I Any construction on the public domain (curbs, sidewalks, driveways, marquees, etc.) will require separate permission. 4 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 successors In interest, agrees to Indemnify, defend and hold N w harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of ; ,l a whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to !.(f modify, waive or reduce any requirement of any city ordinance 1 i nor limit in any way the Cily's ability to enforce any ordinance TOTAL AMOUNT DUE, I provision." tt 11 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 THIS PERMIT This application is not a permit until stale laws regulating construction; and In doing the work authoriz. AUTHORIZES signed by the Building Official or his ed thereby, no person will be employed in violation of the Labor ONLY THE WORK THE Deputy; and fees are paid, and receipt is Code of the State of Washington relating to Workmen's Compensa• acknowledged In space provided. lion Insurance. INSPECTION j ,~ SIGN R OWNER•Q A �� ` u DATE ^IGNE g^' � OFFICIAL'S SIGNATURE DCITYT ref °. �' '"u OF THIS SITE IS LOCATED IN THE CITY EDMONDS OF EDMONDS. LOCAL SALES TAX 775.2525 DATE ATTENTION SHOULD BE CODED 31.04. L-3 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. USC CHAPTER 3. wz 78 PINK — Owner GOLD — Assessor