830390.pdf. W
USE PERMIT
CITY OF EDMONDS -ZONE NUMBER
8303g0
CONSTRUCTION PERMIT APPLICATION -doB -.i) � � J
NAME '(Ofi NAME OF BUSING -ADDRESS `` /) , _ � -^ J, n � y
_LEGAL DESCRIPTION CFI SUBDIVISION 110, NO.
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=PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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EXISTING__ REQUIRED DEDICATION
NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED I 1
ADDRESS
_ STREET USE PERMIT REQUIRED('
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CITY (TELEPHONE
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_ SEE PIW DEPT. REVIEW CHECK LIST DATED
-REMARKS
NAME
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METER S1ZE SUPPLY SIZE UNIT:
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Al E NUMBER
CITY LICENSE NUMBER
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SIGN AREA ENV. REVIEW
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egal escr p Ion o Property. Inclu a all easements
= ALLOWED PROPOSED COMPLETE EXEMPT
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PLUMBING
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NON.RESIDENTIAL
MECHANICAL
❑ REPAIR ❑ RETAINING WALL ❑ SIGN
❑ ❑ EXCAVATE FENCE BY
❑
TYPE OF
CONSTRUCTION (CODE
HEIGHT
-CHECKED
DEMOLISH OR FILL
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P. i- SWIM'REQUIRED SPESPECTd
❑ SNSP. ❑
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IGROUPANCY
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YES 1 NO
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SIDE SEWER WATER LINE =REMARKS
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N NUMBER OF STORIES
NUMBEROF - /� /
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'7' NATURE OF WORK TO BE DONE
UNITS -
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VALUATION FEE
COCCI))) C/ - PLAN CHECK FEE
.. BUILDING
PLUMBING 2 {J 1 %
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MECHANICAL✓
This Permit covers work to be done on private property ONLY. = GRADINGIFB.L
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year- Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
wsuccessors in interest, agrees to indemnify, defend and hold d
harmless the City of Edmonds, Washington, Its officials, a
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 shalt not be deemed to
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modify, waive or reduce any requirement of any city ordinance
i nor limit in any Way the City's ability to enforce any ordinance i TOTAL AMOUNT DUE
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provision." _
/ /
1 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 a 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 of the State o #askington rate g to Workmen's Compensa• ' WORK NOTED
_
-
Deputy; and fees are paid, and receipt Is
in
tlon insurance. % INSPECTION
SIGNATURE (OWNER R AGENT) DATE E4. DEPARTMENT
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acknowledged space provided.
IILIIIIIuIIl,ilelL,l�ll•II NII 4III1 IdJ4iYidlli,LIId111.6llhi lull ll ii.11ii l•�i1i Ilunl_I ill CITY OF
OFF( SIG E
THIS ED IN THE CITY EDMONDSv
SITE IS LOCATED
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OF E DMONDS. LOCAL SALES TAX 775.2525
ATTENTION SHOULD BE CODED 31.04.
(DATE`
7/, R/g-,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
7
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL —File YELLOW —Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102.78
PINK — Owner GOLD — Assessor