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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION joB
ADDRESS /)
NAME (OR NAME OF BUSINESS) zZA �.��j/ lIt'p ClG ��i1PlC I Z�Y� G
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
UJI MAILING ADDRESS
0 Pd` 1?07< 3 IC RIGHT OF WAY PER OFFICIAI STREET MAP.
t ITY TELEPHONE NUMBER
y PURL
-7
G��Yr►a�Ds / ^ �,J `/ C� EXISTING � PROPOSED REQUIRED DEDICATION _ —
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED i
F STREET USE PERMIT REQUIRED ;
w ADDRESS
I= SEE ENGINEERING MEMO DATED
v TELEPHONE NUMBER
CITY REMARKS
NAME
ADDRESS
!' METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
/170
TELEPHONE NUMBER
cr CITY _
I l=D%r1O1-VDS &U/A 77�6 REMARKS
STATE LICENSE NUMBER SIGN AREA ENV. REVIEW ADB NO.
I X14 ti %� n C- % ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements SHORELINE H
(show below or attach four copies)
z
0
a VARIANCE OR CU PLANNING REVIEW BY DATE
EE
o YARDS HEIGHT LOT COVERAGE
FRONT SIDE REAR
W REMARKS
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I
NEW PLUMBING��L,
RESIDENTIAL
FIvj,,) G
AD ALTER COMMERCIAL n MECHANICAL
REPAIR RETAINING WALL El SIGN
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
EXCADEMOLISH OR FILL
I LTE El(ENCE x_FT)
❑ PRE•MOVE INSP.1 ❑ SWIM SPECIAL INSPECTOR AREA OCC PANCY Q OCCUPANT
REMODEL COMPLIANCE INSP. POOL REQUIRED GROUP /� LOAD',`
El YES ❑ NO V
[]WOOD STOVE/ RENEWAL REMARKS
INSERT APT. BLDG
Z PROGRESS INSPECTIONS PER UBC 305
NUMBER OF STORIES LING NUMBER
OF
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Iv SrR u- S r o lv etv In c 5 s
// - �� ,I �c���� VALUATION FEE
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f �r� A r e4i 1 T� 1 Sul7% lL
PLAN CHECK FEE I
^oeG 5BUILDING
✓i l�l `� ` PLUMBING
Oct ��70t MECHANICAL A/� CI`'=
Permit covers woIII rk III t11, o be III done on private property ONLY. GRADINGWILL
construction on the public domain (curbs, sidewalks,
ays, marquees, etc.) will require '111separate permission. STATE SURCHARGE
I.
pplication: 180 Days ENERGY CODE
Limit: 1 Year- Provided Work is Started Within 180 Days
plicant, on behalf of his or her spouse, heirs, assigns and
ssors in interest, agrees to indemnify, defend and hold
ss the City of Edmonds, Washington, its officials,
yees, and agents from any and all claims for damages of
ver nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
z 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 ability to enforce any ordinance TOTAL AMOUNT DUE
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
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
SIGN URE (OWNER OR DATE SIGNED DEPARTMENT
? /z 3/�'1 � 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.
102.87
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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 i
acknowledged in space provided.
LEASED BY:
ORIGINAL — File YELLOW — Inspector; U
PINK — Owner GOLD — Assessor j ,/ 1
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FINAL APPROVAL GIVEN BY:
Initials i Date
Buil0ing
Fire Dept.
Planninh (AD:3)
Engineering �
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pnrclvas. piers
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C,,r�•,�, rar.�q�i
t.}��r};��•• round --
' Rou�ht•in
HEATING SYsIEM
t-RAMING
WALLBOARD
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