870263.pdfUSE PERMIT
ZONE NUMBER
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS 3� g O/y/1 l Y/e`✓
NAME (ONAM OF BUSI ESS){ I LID NO.
Il LEGAL DESCRIPTION CHECK SUBDIVISION NO.
i
MAILING ADDRESi
TELE ONENUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
CITY �/ I ln�,l� �7S _� f 0� EXISTING PROPOSED REQUIRED DEDICATION
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED C
SEE ENGINEERING MEMO DATED
a CITY REMARKS
NAME
hg�d�e / oh -si
ADDRESS METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
Q
O w
a
V TELEPHONE NUMBER 3
CITY REMARKS
z
O
U STATE LICENSE NUMBER SIGN AREA ENV, REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE#
(show below oti attacProp
roue copsInclude all easements
p PLANNING REVIEW BY DATE
VARIANCE OR CU
InHEIGHT LOT COVERAGE
YARDS / f ZS zs1
3.sa/a
-� FRONT L� SIDE REAR
w REMARKS
J
El
NEW
RESIDENTIAL PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR ❑ RETAINING WALL CI SIGN
/
ONSTRUCTION CODE HEIGHT
CHECKED BY TYPE OF C
EXCAVATE ❑FENCE —o„11(�s
DEMOLISH OR FILL x FT)
AREA OCCUPANCY R 3 OCCUPANT
PRE•MOVE INSP.1 SWIM SPECIAL INSPECTOR GROUP ' LOAD
REMODEL L� COMPLIANCE INSP. POOL REQUIRED ❑ YES 0
❑WOODST❑ � RE ARKS RARKS p
INSERTTVEI APT. BLDG RENEWALY
12nor. ilr SC
# Co(9/6 0
NUMBER OF STORIES NL
DWELLING
UNITS
TTACH PLOT PLAN)
OF
m
��i✓�G G
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application:180 Days ENERGY CODE
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 PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
modify,.waive or reduce any requirement of any city ordinance TOTAL AMOUNT DUE
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 ATTENTION
information given is correct; and that I am the owner, or the duly THIS PERMIT
authorized agent of the owner. I agree to comply with city and
state laws regulating constructionLabor ; and in doing the work authoriz- AUTHORIZES
IZ ES
ed thereby, no person will be employed in violation of the WORK NOTED
Code of the State of Washington relating to Workmen's Compensa- INSPECTION
tion-Insurance. DA SIGNE DEPARTMENT
SIGNA RE%O�%Nf�R OR GENT) � , J � „// 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
//
SOD
l00
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.
is
BY:
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor r
:!'t?2"•s\=+tlY.} ~'7i •' {., .•i .v T���y},�+,-N/J�ytYJ�1. M �y h s �.
!: �yun: M �.4, r+Y.YVY •Jx:[..,ity nK , t, f.t. U,, S"S. 1 fi �( taR �.H F.Y •S�.+rr�1x!t Y.',,
"1. :4.1 � Q• :\1at J it. L'T •'+{:'}} ,% f, F'.. F.•t v� 1',��y� +' i 1S �"'�i' �'y� . � ... •1{!
Y 1a xf 1.+Ar { hli+G'1 �i/r+T Sig' �: yf. / 4 v4#. \Fdt�1. 7 Syy <'P,. R(a `f7)i+�i
1 q 7
iL�1'Y �%1 �}•s+'t 1. � A t� t•+. •r'�• � ''.� `i+ . i - J .,. ... .. i s 1
.v r
f
1
:
It I
It
• 5
It
.. e--...... -...: ,. . 5
41,
- f :ir t, li�'f f :. \• a '., ..
t
+
All-
n.
•
t
It
It
A I
RECORD OF INSPECTIONS ,
Date Passed
FOUNDATIOR
House — -
FINAL E1' Porches) piers
late
Retaining; walls
Bui! i-1 Garaa,e, carport
PLU(%ABING
PLAr:::: s Underpround --- -
Cntu:ec::.;� Rough•in