850326.pdfUSE PERMIT
CITY OF EDMONDS ZONE NUMBER
- CONSTRUCTION PERMIT APPLICATION
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CHECK NO. LID NO.
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/Mou��/¢C.J�j LEGAL DESCRIPTION SUBD ISIO
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MAILING ADDRESS
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CITY�/yj TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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RE.U.RE.DEDICATION____.
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NAME
RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED 1_i
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STREET USE PERMIT REQUIRED:.'.
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x SEE ENGINEERING MEMO DATED_. .._.__
C CITY TELEPHONE NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED.___ —
REMARKS
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NAME
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ADDRESS
O METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
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CITY TELEPHONE NUMBER
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oREMARKS
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U STATE LICENSE NUMBER CITY LICENSE NUMBER
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SIGN AREA ENV. REVIEW ADS NO.
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ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property •include all easements
(show below or attach four copies) SHORELINE p
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VARIANCE OR CU PLANNING REVIEW BY DATE
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YARDS LOT COVERAGE
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REMARKS
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❑ NEW y3 RESIDENTIAL ❑ PLUMBING
❑ ❑ ❑
ADDIALTER NON-RESIDENTIAL MECHANICAL
❑ ❑ WALL ❑ SIGN
REPAIR RETAINING
EXCAVATE lI�Q�7Lj7� P��1fJ1E / CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
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DEMOLISH❑ OR FILL JL�4 .&_ X F'f)
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INSPECTOR AREA
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COMPLLIIANCESINSP. POOL REQUIRED GROUPANCY LOCADUPANT
❑ ❑ ❑ REMARKS :,NO
SIDE SEWER WATER LINE
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❑ ❑ ❑
M NUMBER OF STORIES NUM flER OF / �y/Nr.S �L�.�1/
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION FEE
PLAID CHECK FEE
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n"N BUILDING
�' 7 8� PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGWILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. 1?oy-(.-_
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,
s 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 �-
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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 zo g,?-3
provision."
I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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 This application is not a permit untll
state laws regulating construction; and in doing the work authoriz- AUTHORIZES his
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or
Code of the State of Washington relating to Workmen's Compensa. WORK NOTED Deputy; and fees are paid, and receipt is j
acknowledged in space provided.
lion Insurance. INSPECTION
SIGNATURE (OWNER OR AGENT( JDATESIGNED DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE ;..�
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/�lit.tr'rt-O�n-.t— ` J% EDMONOS
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ATTENTION nfsTE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor � --
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RECORD OF INSPECTIONS
1 Date Passed
FOUNDATION
House
Porches, piers
Retaining walls:
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Garage, carport _— _--
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=LUNIBINr
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Water sarvice - -
HEATING SYSTEM
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FRAMING
WALLBOARD
FINAL
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IMPORTANT! Press Firmly While Writing Ar(ilicatiou!
Building Relocation
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Perml$
Applicant Fill
Inside Heavy Lines
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PERMIT
I NUMBER -- / p171
OWNER'S NAME
NEW SITE ADDRESS
AIL G DDRE99
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•DMONDS
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PRE -MOVE
INSPECTION
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CITY &ZONE
TEL. NO.
PERMIT NO.
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FIRE
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BLDG. PERMIT NO.
FOR
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ZONE
WORK
AT NEW SITE
bIOVING CONTRACTOR
MOVE CONTRACTOR'S INSURANCE COVERAGE
STREET ADDRESS '
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NAME OF SURETY
PROVIDING P.L. &
P.D. COVERAGE
La 277d -23, el 5 1 -7 1r
CONTRACTOR'S STATE N CITY BUSINESS
LICENSE NO, c�3-QI•-J %,i9 LICENSE NO.N
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SITE DESCRIPTION
ADDRESS OF PRESENT BUILDING SITE ,
— (Show below or
,ZONE & STATE
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VALID INSU NCE PO CY CHECKED BY: DATE
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BUILDING DESCRIPTION
DESC BE BASIC CONSTRUCTIOA &PRESENT USE OFF BUILDING:
OVERALL LENGTH OF BUILDING:
ar IT.
POLICE DE T. APPROVAI
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Time to Commence Moving:
�. Time to Finish Ma
FIRE DEPARTME
/ i/UC ei%1dc? RI—� T By:
ENGINEERI C
c�--�. _. A',- 'y A P 1
CLEARED BY:
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RELOCATION
PowerCompany ❑........................................................................................
PERMIT '
FEE
Telephone Company ❑
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NAME OF OWNER OF PRESENT BUILDING SITE
ATTENTION:
MAIL OR HOME ADDRESS
THIS PERMIT
AUTHORIZES
ONLY THE
I hereby acknowledge that I have read this application; that
RELOCATION
the information given is correct; and that I am the owner, a
OF THE
duly licensed moving contractor, or the authorized agent of one
BUILDING
of these. I agree to comply with city and state laws regulating
NOTED
building relocation; and in doing this work, no person will be
employed in violation of the Labor Code, State of Washington
relating to Workmen's Compensation Insurance.
Signature of Owner,
Contractor, or
BUILDING
INSPECTION
Authorized Agent .......:........6...:...1......1......................
DEPARTMENT
Signer's p
No.
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EDMONDS
City ....IC%12.a2>. Ql ....W..S./i-.... _............................
Pit a -no:
Date..............::..1.....8..-..`7...f ...............--...........--........- .......
rH AS LOADED BLDG. AREA
a " FT. I SQ. FT.
Olf OjpVIINROUTE
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RANCE OF ROUTING TE
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;/71
DATE °
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RFC EI T NO.
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PERMIT APPROVAL
THIS PERMIT DOES NOT BECOME
VALID UNTIL SIGNED BY THE
BUILDING OFFICIAL OR HIS DEPU-
TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE
SPACE�jIjROVIDEDj
By.................. ...............
1 Dhector's Signature
e
Date.......... ^..(...-......t...1.......
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DISTRIBUTION OF COPIES
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDENROD — Police Dept.
PINK — Moving Contractor