850208.pdff` J
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
USE
ZONE
JOB
ADDRESS
MENOMONEE
PERMIT
NUMBER
LID NO.
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
HAPD�✓OS ��,,5 906 EXISTING REOUIREDDEDICATION
,n� PROPOSED �ry
NAME 6�/k '' 8 � /'..V 70 O cr
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑ w
----� STREET USE PERMIT REQUIRED ❑ Z
w ADDRESS Z
= SEE ENGINEERING MEMO DATED_ — -
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CITY TELEPHONE NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED
REMARKS
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- NAME
ADDRESS d op
0 METER SIZE BU DING SUPPLY SIZE FIXTURE UNITS
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CITY TELEPHONE NUMBER
~ REMARKS 3
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0
O STATE LICENSE NUMBER CITY LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property- Include all easements SHORELINE#
(show boloyc0) attach four copies) -
oC�nyr�tfc,0111CLYCIKIv V 6�
QSiJVvtr, xrjy `) �.iyt(�ti( . r� Z3 p �Z3/ ���'Qtt'S VARIANCE OR CU PL NNING REVIEW BY DAT
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FRONT SIDE REAR �� .® z
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S'ki�ti. eF i>�s 11 �
❑ NEW ❑ RESIDENTIAL ❑ PLUMBING
ADDIALTER ❑ NON-RESIDENTIAL ❑ MECHANICAL
❑ REPAIR ❑ RETAINING WALL ❑ SIGN
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
❑ 60
DEMOLISH ❑ OR FILLTE ❑ 1 ENCE x—� _ (��dars
❑PRE -MOVE INSP.1 ElSWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP. POOL REQUIRED /' GROUP LOAD
❑ YES
❑ SIDE SEWER ❑ WATER LINE ❑ REMARKS
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WNUMBER OF STORIES NUMBER OF
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m UNI I S
NATURE OF WORK TO BE/D'�ONE (ATTACH PLOT PLAN) 171
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VALUATION FEE
TOPLAN CHECK FEE
—"Woor ,.
I-�OL BUILDING
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application:180 Days
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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
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
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
I hereby acknowledge that I have read this application; that the
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
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
y 21Y ,4?s
PLUMBING
MECHANICAL
GRADINGIFILL
TOTAL AMOUNT DUE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit until
AUTHORIZES ONLY THE sig y g signed b the Building Official or his
WORK NOTED Deputy; and fees are paid, and receipt is
INSPECTION acknowledged in space provided.
DEPARTMENT
OFFICIAL'S SIG R
CITY OF
EDMONDS
771.3202 DATE oe r /
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
C'HAPTFR 3�
OR(GIiQAL — File � YELLOW — Inspector U
APR 2 51985 PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS
...Date Passed ` X.`
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FOUNDATION . _ t
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House .
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_ . :: Porches, piers --
walls
Retaining , ;:�
_... ._ gage. carport
PLUMBING
Underground -i'.,
Rough•in
Water Service
HEATING SYSTEt%t--------
j AMING 'S
,WALLBOARD
FINAL
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