840286.pdfc. .
CUSE PERMIT
CITY OF EDMONDS ZONE NUMBER 1840296
CONSTRUCTION PERMIT APPLICATION jog
NAME (OR NAME OF BUSINESS) ADDRESS ' O MJ91
L, C
Q / F . / LEGAL DESCRIPTION CHECK SUBDIVISION O. LID NO.
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CITY TELEPHONE NUMBER
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NAME
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CIT TELEPHONE NUMBER
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NAME
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ADDRESS
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CITY TELEPHONE NUMBER
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U STATE LICENSE NUMBER CITY LICENSE NUMBER
Leaal Description. of Property - Include all easements
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED -• — ---
SEE PIW DEPT. REVIEW CHECK LIST DATED
REMARKS
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SIGN
ALLOWED
/ ARIA
T NCE OR CU
YAR
DSwl OF FRONT
,c FoL_ TR A Cti W c o X D tenecia
❑ NEW RESIDENTIAL ❑ PLUMBING
IJ ADDIALTER ❑ NON-RESIDENTIAL Cl MECHANICAL
❑ REPAIR ❑ RETAINING WALL
EXCAVATE
❑ DEMOLISH OR FILL
❑PRE•MOVE INSP.I
COMPLIANCE INS
❑ SIDE SEWER ❑ WATER LINE
NUMBER OF STORIES NUMBERO
7 UWtLLING
UNI IA'
NATURE OF WORK TO BE DONE (ATTACH PL(
BUILDING SUPPL
❑ SIGN
❑FENCE CHECKED BY TYPE
( x _FT)
SWIM SPECIAL INSPECTOR
POOL REQUIRED
0 YES C NO
ElARKS
❑
PLAN)
E UNITS
2
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SIDE
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AREA
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,CJ�) PLAN CHECK FEE
ST ffdolVE i "' SrA/RW A C�E BUILDING
1b S457V6' /CL_OOQ.S PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
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
u, successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
swhatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify,.waive or reduce any requirement of any city ordinance
°x 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
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
tion Insurance. INSPECTION
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF
EDMONDS
771.3202
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
CQ�
ENV. REVIEW
COMPLETE I EXEMPT
PLANNING REVIEW BY
ADB NO.
SHORELINE N
DATE
LOT COVERAGE
36 /i� P71
OCCUPANCY
GROUP n�
03
rAl
LOAD
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OF5qAL'S SIGNATURE
ORIGINAL ` File/ YELLOW — Inspector U
PINK — Owner GOLD — Assessor
Kenyon Pnn4np . EOmon05 VGA . 7759K9K
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FINAL
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