870200.pdf`1
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CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION joB
ADDRESS
NAME (OR NAME OF BUSINESS)
TNOMAS SNM)GOU LEGAL DE
19 p L
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NAME
WIC
ADDRESS
16
CITY
L�
STATE LICENSE NUMBER
Legal Description o Prope
leh„w h'Inw er attach four
PERMIT
NUMBER 970200
1eW
DIVISION NO. ILID NO.
TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
6
NUMBER
Include all easements
II NEW K.7 rOlucn 1In6
ADD/ALTER JE1 COMMERCIAL
REPAIR 1:1RETAINING WALL
❑ EXCAVATE
DEMOLISH OR FILL
❑❑ PRE•MOVE INSPJ
REMODEL COMPLIANCE INS
WOOD STOVE/
INSERT
FN APT. BLDG
NUMBER OF STORIES NUMBER C
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLI
PS
4N t A 1111I �S
LJ PLUMBING
MECHANICAL
'❑` SIGN
DFENCE
(.x_FT)
n SWIM
11 RENEWAL
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED El
STREET USE PERMIT REQUIRED C
SEE ENGINEERING MEMO DATED
METER SIZE
REMARKS
•� SIG—
ALLOWED
VARIANCE OR CU
YARDS
FRONT
SUPPL
UNITS
PROPOSED I COMPLETE
SIDE REAR
EXEMPT
REVIEW BY
D1Z..
abi-i
DATE
HEIGHT I LOT COVERAGE
W
Q
3
rREMARRK-S
TYPE OF CONSTHUonVry ..���
PECTOR AREA OCCUPANCY OOCACUUPANT
^❑ NO-S Oc677D�
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 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 StRLqgjWashington relating to Workmen's Compensa•
4TE SIGN
q/a i,
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATESURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771.3202
G
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
BY:
DATE
ATT5 NM N
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL CE TFIFICATE INSPECTION OCCUPANCY HAS EN ADE N BEENGRANTEDA
L OR
AUBC
CHAPTER 3,
102 78
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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RECORD OFAN
INSPE
FOUNDATIO(y a
House
FINAL APPROVAL �rI'1�1�;
in* VeIS I md,fz Porches, piers
Retaining walls
Building
Garage, carport
Fire Dept.
- —� PLUMBING
Planni,121,
Underground
„Engineermd '
t
Rough•in
Water service
HEATING SYS "EM. #
FRAMING I
WALLBOARD,
FINAL
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