830394.pdf- ... CITY OF EDMONDS
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ZONE NUMBEfl 830394
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CONSTRUCTION PERMIT APPLICATION
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NAME TOR NAME OF BUSINESS)
ADDRESS
LEGAL DESCRIPTION CHECK SUBDIVISION
NIT.
LID NO.
MAILING ADDRESS ,
Gil
TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING___ REQUIRED DEDICATION
V
NAME
PROPOSED___
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED I I
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ADDRESS
STREET USE PERMIT REQUIRED I'. z
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SEE ENGINEERING MEMO DATED
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CITY
TELE PHONE NUMBER
SEE PIW DEPT. REVIEW CHECK LIST DATED
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REMARKS
1
NAME
ADDRESS
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METER SIZE
BUILDING SUPPLY SIZE FI%TURE
UNITS
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T(E�L,E`PHONE NUMBER
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REM1�AR�K/S
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STATE UC ENSE N MBER
CITY LICENSE NUMBER
ILS
SIGN AREA
ENV. REVIEW
ADS NO
Legal Description of Property - include
all easements
ALLOWED
PROPOSED
COMPLETE
EXEMPT
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(show below or attach four copies)
I(z, SHORELINE
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
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REMARKS
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❑
❑
❑
NEW
RESIDENTIAL
PLUMBING
❑
❑
❑
ADD/ALTER
..".RESIDENTIAL
MECHANICAL
❑ ❑ ❑
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
❑ ❑ ❑
CHECKED BY
TYPE OF CONSTRUCTION CODE
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HEIGHT
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DEMOLISH OR FILL 1—x_FT)
POOL
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❑ SINSP.
INSPECTOR
AREA
LOADPANT
COMPLPRE-MLIVE IANCE POOL
REQUIRED
JOCCUPGROUP
LOAD
❑ SIDE SEWER ❑ WATER LINE ❑
I I YES NO
1
REMARKS
❑ ❑ ElITJSZ
AwtiT(� ER rr Cove I ,S.S
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NUMBER OF STORIES
NUMBEROF
CR9 Gj�.(�-Eu`TkOQ.� Col(ZO�
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DWELLING
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m
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLANT
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VALUATION
FEE
PLAN CHECK FEE
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PLUMBING
Pl�v. i/v' _
private
MECHANICAL
This Permit covers work -be done on proper y ON�
GRADING/FILL
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Any construction on the pu611cdoms n,curbs _Stdewafks,
driveways, marquees, etc.) will require separate permission.
UGC-
1-5
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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
)
in interest, agrees to Indemnify, defend and hold
{ -
wsuccessors
harmless the City of Edmonds, Washington, its officials,
-�
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
i of this permit. Issuance of this permit shall not be deemed to
0 modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
3 ��
provision."
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
state laws regulating Construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application Is not a permit until
/
ed thereby, no person lj bee ptoyad in violation of the Labor
ONLY THE
WORK NOTED
signed by the Building Official or his
Deputy; and lees are paid, and receipt is
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Code W- State of W s n relating to Workmen's Compensa-
do fnsu ce.
INSPECTION
acknowledge in space provided.
SIGNA N / DATE SI NE
DEPARTMENT
CITY OF
OFFICI '
"""""" ����
THIS SITE IS L- CgIED IN THE CITY
EDMONDS
OF EDMONDS. LOCAL SALES TAX
ATT ION SHOULD BE CODED 31.04.
775-2525
oat
-_
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR ORIGI AL — File YELLOW — Inspector
j
(
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
CHAPTER 3.
UBC
t E R J 1983 PINK — Owner GOLD — Assessor
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Retaining walls
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HEATING S1 S i E"-,i
FRAMING
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FINAL
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