840243.pdf_
1 CITY OF EDMONDS
USE PERMIT /+
ZONE A NUMBER 8' {'j0243
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CONSTRUCTION PERMIT
APPLICATION
JOB
NAME (OR NAME OF BUSINgonr=grESS)
ADDRESS I Q,��� ot� p1G \ M ` t r
IC((RI//PTI �'ON
VILILD
1.4�
777 \\\
LEGAL DES CHECN SUBDI_Vi151'OVN`NO. IJWO.
w MAILING ADDRESS
CITY
TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
MaV-11 T /^
l�
EXISTING__.__- REQUIRED DEDICATION
NAME
PROPOSED_ -___.__-
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED'
w ADDRESS
STREET USEPERMIT REQUIRED.
u
SEE ENGINEERING MEMO DATED _...... ... .. ...... .... .... ....... .... ..
e CITY
TELEPHONE NUMBER
BEE PIW DEPT. REVIEW CHECK LIST DATED
unVVI
10/'Z 4Z uv -/
METER SIZE BUILDING':UPPLY SIZE FIXTURE
UNITS
D'C"
GIT r TELENE NUMDEfl
L� , 2 1/l1 �7
REMARKS
O
STATE LICENSE NUMBER CITY LICENSE NUMBER
MW7T I1___.W, 1-15 KC
SIGN AREA
ENV. REVIEW
ADS NO.
Legal Description of Property- Include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
0
(show below or attach lou r copies)
SHORELINE 1
2
VARIANCE OR CU PL
NING VIEW B�Y,.,��(
D�A/TG/E-
uri
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_ /
a
YARDS
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LOT CO/V�ERAG
3
FRONT O SIDE
25 REAR
REMARKS
ElNEW C jam' RESIDENTIAL ElPLUMBING
❑ ❑
w1�/�/I� AD.ALTER NON-RESIDENTIAL MECHANICAL
ElRETAINING ❑
1 REPAIR WALL SIGN
EXCAVATE FENCE
loll DEMOLISH ❑ OR FILL ❑ (-x_Fn
CHECKED BY I T PE OF
S
CTION CODE HEIGHT
/' 7
❑PRE -MOVE IN%1 ❑ SWIM
POOL
SPECIAL INSPECTOR AREA
OCCUPANCY
GROUP
OCCUPANT
COMPLIANCE INSP.
REQUIRED /
YES ✓ NO
,�
LOAD
❑ ❑ ❑
REMARKS
SIDE SEWER WATER LINE
w
NUMBER OF STORIES INUMREROF
p
m
UWtLLINU
UNIIJ
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)'
- PLAN CHECK FEE
NUBUILD114G
'1 O
✓�
l PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
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
successors in interest, agrees to Indemnify, defend and hold
1 harmless the it of Edmonds, Washington, its officials,
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 modify, waive or reduce any requirement of any city ordinance
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 ATTENTION
Information given Is correct; and that I am the owner, or the duly
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
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
lion In ranee. INSPECTION
Si RE 10 NE R SIGNED DEPARTMENT
This application Is not a permit until
signed by the Building Official or htil
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
-
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jn4E
Z1,4- E ITONDS
ATTEN N 7713202/ DATE
Ilk
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGI L — File -'YELLOW 7/ Inspec or
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. n ! APR r� G r�98
�rT4 PINK —Owner GOLD —Assessor
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SETBACKS:
FIRONT
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REAR
OTHER
HEIGHT -- —2.L-1
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60TITA&e
CITY OF EDMONDS
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BLDG. DEPT.
CONDITIONAL PERMIT
WORK
ADDRESS;/,7c/.2,Z)
OWNER ,.A� �_
.ED—
APPROy
Bp
BLDG. OFFIC L
KEEP THESE STAMPED
PLANS ON JOSSITE FOR
ALL INSPECTIONS
PERMITWNO. I
SHEET
0243
or
17 ......... .......
r5-,A, tom. FL -
APR 271984