880329.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)It
MAILING ADDRESS
% 3Ud. paln0c We/4/ " T HONE NUMBER
A
NAME
ADDRESS I'
CITY
STATE LICENSE NUMBER
L tines pl otr attach four copies) u
rool
TELEPHONE NUMBER
O
TELEPHONE NUMBER
v r1 4 -ADS'
easements
USE (PERMIT
ZONE 'INUMBER ����✓//
JOB I
ADDRESS 1306
6 ! l 1Im pIC file
C 111
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LEGAL DESCRIPTION CHECK SUBDIVISION NO.
LAPPROVED
PUBLIC RIGHT OF WAY PER OF11DEDICATION
T MAP.
EXISTING ___._ REQUIRED —__----
PROPOSED _.___-_---
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
REVI
SEE ENGINEERING MEMO DA4ED
REMARKS
LJ NEW IUD RESIDENTIAL IJ PLUMBING
COMMERCIAL MECHANICAL
ADDIALTER n
REPAIR El RETAINING WALL L. I SIGN
EXCAVATE ❑ FENCE
DEMOLISH CI OR FILL ( x _FT)
PRE -MOVE INSP.I ❑ SWIM
REMODEL COMPLIANCE INSP. POOL
�WOIN ER STOVE
EI APT. BLDG RENEWAL
NUMBER OF STORIES
NATURE OF WORK TO BE DONE
NUMBER OF
DWELLING
UNITS
WA-C-H PLOT PLAN)
METER SIZE
REMARKS
SIGN AREA
ALLOWED I PROPOS
VARIANCE OR CU
YARDS
FRONT SIDE
p15cHARy�
t�1
PPLY
FIXTURE UNITS
ENV. REVIEW ADB NO.
COMPLETE I EXEMPT
ING REVIEW BY I DATE
REAR
Q' g5oolrms
HEIGHT i LOT COVERAGE
to � pucTS
;NECKED BY ITYPE RF CUNZainulool"w"
T_0 19e75
AREA OCCUPANCY OCCUPANT
SPECIAL INSPECTOR GROUP A �"7� LOAD
REQUIRED Al J
C; YES NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
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T� PE Imo r.EG.v
//OOP -SY E� �� �� ` _ �w PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
Thi
s Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curls, 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 PIP t�
"Applicant, on behalf of his or her spouse, heirs, assigns and ('9
n successors in interest, agrees to indemnify, defend and hold
12 harmless the City of Edmonds, Washington, its officials,
f from any and all claims for damages of
employees, and agents
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
it. Issuance of this perm
of this permit shall not be deemed to
omodify, 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." that the
I hereby acknowledge that I have read this application; e duly ATTENTION
information given is correct; and that I am the owner, ith cor ity and
authorized agent of the owner. I agree to comply Y THIS PERMIT',
ONLY THE
horiz-
state laws regulat��Ir on will betemployed noviolation of theing the work Labor
AUTHORIZE
ed thereby, no p WORK NOTEI)
Code of the State of Washington relating to Workmen's Compensa INSPECTION
tion In I`$nCe. DATE SIGNED DEPARTMENT
SIG 14 E OWNER OR A E T) CITY OF
u� 3 EDMOND$
771-32Q2
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 1,7
UNTIL ANLNSPO O UPANCYE BEN HAS ABEENNGRANTEED. UBC(�
A CERTIFICATE
CHAPTER 3.
102.87
VALUATION I FEE
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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.
DATE
OFFICIAL'S SIGNATURE fln
DATE
RELEASED BY:
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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RECORD OF
INSPECTIONS
Date Passed
FOUNDATION
House
Porches, piers -
Retainine walls
Garaf;r, carport
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