870144.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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ADDRESS
STATE
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"o` PERMIT
ZONE NUMBER V 70 J
JOB 4/ j� �'Yr
ADDRESS � C� !�/r%li a��1�2,�1G rye v✓,O/'�
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. TLID Nn
\�/ j� �, TELLEEP�HJONEE NUMMBEE�R/� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
0 • "' ' + / f I'�/ iC/�-� EXISTING REQUIRED DEDICATION
PROPOSED
E NUMBER
TELEPHONE NUMBER
4401-S6c�
a ws✓ 280 G,j
Iscription of Property - Include all easements
flow or attach four coDlesl
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
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METER SIZE IBUILDING
REMARKS
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SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
409�w/4-4,11VE j0A4W/Y F�+zoM
AwPARAuaf. TGTt N,�df=t.+'drt� VARIANCE OR CU
V . �y irk & e� �.,� � YARDS
5/WIyei✓Y� 4;14L 4n� :r:'Vlv7' yX�/N�� FRONT SIDE
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NEW I2 i RESIDENTIAL PLUMBING e�
ADO/ALTER El COMMERCIAL MECHANICAL
I� REPAIR RETAINING WALL SIGN
EXCAVATE FENCE CHECKED BY T`
DEMOLISH OR FILL (—X---FT)
❑ PRE -MOVE INSPJ ❑
REMODEL COMPLIANCE INSP. POOL REQUIRED
SWIM SPECIAL INSPECTOR
❑ WOOSTOVE/ DYES 0
APT. BLDG RENEWAL REMARKS NO
INSERT
NUMBER OF STORIES NUMBER OF �-� -
2 DWELLING /
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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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
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns ands
o successors in Interest, agrees to indemnify, defend and hold
3 harmless the City of Edmonds, Washington, Its officials,
cemployees, and agents from any and all claims for damages of
c 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. 1 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-
r
DATE SIGNED
3/9 1,i;5�;z
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
P?
TOTAL AMOUNT DUE
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.
10240
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771.3202
W4
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REVIEW BY
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ADB NO,
IORELINE N
DATE
HEIGHT I LOT COVERAGE
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CODE HEIGHT
OCCUPANCY, V OCCUPANT
GROUP LOAD
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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.
'S SIGNA%TURE, DATA
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS'' `
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FOUNDATION 1.
HouseIlk
, w+.
Porches, piers _.
TINAL APPROVAL GIVEN BY: Retaining welts
Initials Date
Gara;e, carport --- .
Building PLUMBING
Fire Dept. ! Undenuound _—
Planning (ADB) I Rough -in \
Engineering I : Water service
HEATING SYSTEM
.3 S %�7 FRAMING
/ y WALLBOARD
FINAL. -
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