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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BNSINESS)
U
I (VL bA
y
14 Cl
ADDR SS
o. C90 %k C
NUMBER
TELEPHONE NUMBER
�7 7(,--3 7( ,
VE NUMBER
I_C 1.
'I [
of Property • Include all easements
ach four CODies)
l=J NEW RESIDENTIAL PLUMBING
ADD/ALTER COMMERCIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCADEMOLISH OR FI LTE ❑ `ENCE x_F)
❑❑ PRE -MOVE INSP.1 ❑ SWIM
REMODEL COMPLIANCE INSP. POOL
❑ WOO INSERT F1 APT. BLDG RENEWAL
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
ILY ) 5 /1)EV64�E
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."
USE PERMIT
ZONE NUMBER g770Sm% 6
SOB ADDRESS 3 /D
LEGAL D
yE
�SC
jRIPTION CHECK SUBDIVISION NQO./ LID NO. %J
to
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING RE DEDICATION
PROPOSED lf� r
RIGHT OV WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED C
SEE ENGINEERING MEMO DATED /•,iA/ f7
L
.. AV
�D O
iTEZBUILDING 11
UPPLY SIZE (FIXTURE UNITS
Y)
�1\ y ,ecp.D
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
1a
VARIANCE OR CU PLANNING RE REVIEWY DATE 1
c�7
YARDS a HEIGHT LOT COVERAGE
FRONT�� SIDE � REAR AR p�, tv
CHECKED BY
WA
/_TIMT
REQUIRED
❑ YES ❑ NO
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I CODE HEIGHT
148s .Zs
OCCUPANOCCUPANT
P,3
GROUP LOAD
l796 o
is kr a6i 3oS
TION
PLAN CHECK FEE ' 2co
BUILDING O 2�S 4103
PLUMBING J 33
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE !
�5
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
[a'uthorized
formation given is correct; and that I am the owner, or the duly ATTENTION
agent of the owner. I agree to comply with city and THIS PERMIT
tate laws regulating construction; and In doing the work authoriz• AUTHORIZES
d thereby, no person will be employed in violation of the Labor ONLY THE
ode of the State of Washington relating to Workmen's Compensa- WORK NOTED
on Insurance. INSPECTION
G ATURE (OWIN'EiR OR �AGNT)( DATE SIGNED DEPARTMENT
�W 1) ✓ I ` �� J� CITY OF
EDMONDS
'`"771.3202 (`
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE DEC - 4 1987
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3, Ir"Ehh'i1T C!`!1"'TE!
102.78
--/00,0o 1 4�0&9S
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.
OFFICIAL'S SIGNATURE DATE
12.2$•$7
ELEASED BY: UAI
J2[� 3/ 8
ORIGINAL — File YELLOW — Inspector
U
PINK — Owner GOLD — Assessor
REAR
OTHER RECrI, VED f.
HEIGHT _ 251MOW CITY CO
DEC - 41987
PERMIT COUNTER
PLANS ON jOCSITE FOR %J
b
ALL INSPE• TIONS ri
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PERMIT NO. SHEET ;
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COMMUNITY SERVICES
ENGINEERING/BUILDING
FINAL FORM
MEMO TO: Building Division
FROM: Engineering Division SUBJECT ADDRESS: 1'/
�ew
I. [ePERMIT APPROVED FOR FINAL
PERMIT NOT APPROVED FOR FINAL
Requirements:
1. .
2.
3.
4.
7 Zo�g
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,
r. RECORD OF INSPECTIONS
Dates d
• FINAL APPROVAL GIVEN BY: / ..
.. I FOUNDATION
Date • ' '
�'•,, }louse
Building 3' _._._........,.
porches, piers
fDew ;. _.._....:.
ire
�.I Retaining walls -
Lngineeri!-.-_•......o... I Garage, carport
rk
PLUmE
Underground
t • ;, Rouah4n
Water
}{EATING SYSTEM
z —ST--?'s1� +s. FRAMING
yVALLBOAW1 . ZD• �� ` jT 6
FINAL cry