880541.pdfPERMIT
CITY OF EDMONDS ZONE NUMBER®1
CONSTRUCTION PERMIT APPLICATION JOB /_f��
NAME (`OR NAME OF BUSINESS) ADDRESS �%f I/�! I /^/` /// R 114E
L %hL r'�r1�ILJ p/=( k I`- I C 4u rk\ LEGAL DESCRIPTION CHE/CKK LUBDIIVISI(ON NO. F ( LID No.
LMAILING ADDRESS / rD S— Z 747 l �Tl
CITY TELEPHONENUMBER // PUBLIC RIGHT
OF WAY PER OFFICIAL STREET MAP. APPROVED BY
:/\ ►1 LA-1-10& � L' j S� - V EXISTING �0 _ REQUIRED DEDICATION —Q _
NAME PROPOSED
Z
RcrfN,CR e. (- (,� �'C�\ RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED. , w
•V ADDRESS STREET USE PERMIT REQUIRED ; Ak co
Z
j SEE ENGINEERING MEMO DATED R IEW BY W
CITY / TELEPHONE NUMBER
REMAR
NAME V� f M
cc ADDRESS
U5-io ���� �,� METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
CITY TEL NUMBER �/cc
w
r
Z REMARKS a
0
U STATE LICENSE NUMBER K 7/// fPr
lni� �10Z C�J SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property - Include all easements ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies) - SHORELINE H
Z
0
a ( /�
v 5 Q a•{ jG�L{�e� `�-�r �e �S VARIANCE OR CU PLANING %LAANN G REVIEW BY DATE
o 1. 8 0
a / / 5 YARDS HEIGHT LOT COVERAGE Z
�✓ D ✓� ;
W FRONT � SIDE /O REAR Z' LS 3S !`; Z
REMARKS g
KI NEW ILJ RESIDENTIAL LJ PLUMBING
❑ ADDIALTER ❑ COMMERCIAL ❑ MECHANICAL
❑ REPAIR ❑ RETAINING WALL
EXCAVATE
DEMOLISH OR FILL
❑ PRE -MOVE INSP./
REMODEL COMPLIANCE INS
❑ WOOD STOVE/ ❑
INSERT APT. BLDG
w NUMBER OF STORIES NUMBER OF
o DWELLING
m � W 1f�k 7j3rWv^0^T UNITS
0
'+ NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN
C0L4 r ew
R 0S
USE
;/I
AFENCE
' (/
ECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
ECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
QUIRED GROUP D LOAD
)YES !: NO /lMARKSROGRESS INSPECTIONS PER UBC 305
I ®l7h5rRn1l9G- .TIsl/z,Q.El2 lggdb W/3 &Vrn&I/ c_n,04
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
N successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
5 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 PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
° nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
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 ATTENTION
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
S�IG% TURE (OWNE�p OR AGJENT) / DATE SIGNED DEPARTMENT
CITY OF
EDMOND�
ATTE .771 =32e.Al
IT IS UNLAWFUL TO USE OR OCCUPY . STRUCTURE
-
.A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
-
VALUATION I FEE
—I oQ. fib 9673
,•er-72�A70 life/
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.
OFFICIAMsE DATE
.111fASED BY: DATE
1 �I?
ORIGINAL — File YELLOW — Inspe c
PINK — Owner GOLD — Assessor
ram•
Rosso
1?t tout. . ,, �� TVI
�4 �;.r�. c�•,v
-S
PIc.n5
!A i v i ^9 ti (� t tQ rj'110
r�
1 pi I P" sale t f� 1 Gt
tPR� ACEA pIAAI UIVO'H A I1 0
sQ.__ zy_ 3/.—
Pa. o 7 o (t2 ns
(3ed+-cow.S I&qo \ w+nu5 .c��tQN1aNG uVC (ohlfi'}lc'sk`)
\'rIVE•wAYS woo
3Sa
JUL 29 1988
waJ
PERMIT COUNTER
I
TAT
duous
�( e SEC I� CO'JJII Cis
tameire 1^ nc,(r.e5
v1 ,
iree-S '�hti
i i'.iit{4 f ZIWr:
I\
r"
4
_
Ji 1
(•
J'
}13
,
Date Sent to Engineering
;t I
1:
N
It
PI
r
ENGINEERING APPROVAL FOR OCCUPANCY
Ito
MEMOMEMO TO* Permit Coordinator
Building Division
FROM: Dan Smith
Engineering Inspector
DATE:
SUBJECT ADDRESS:D/yr41 ///,
SUBJECT NAME:
/d 4/0�r�
I, PERMIT APPROVED FOR FINAL
IIe PERMIT NOT APPROVED FOR FINAL
Requirements:
2.
3.
4.
'yitrv' ^ti'�'Zt1�`irt r
c
.,. ti ,io54Vyr1 �p �•
At
r fir. .-... .V �... ••.v .� -.� ..� ... +�.. _ 1 ' ♦ ..� ...r.r� .. . .. _ - , .
...... w ..ram..:....... „_ ...
.. ..�h, , .,.NMf....,n.....� wnwr,-�r+�T t'•eiaw �� e+i:�,ii:n. tl� ......�1.
N�M�S�rrt'Y.{.
LrFx, x1, I . rr a i It i ._ n• Y! �nw a0. .A. Ti'T^,
Y`�",L:n�% .,(..i. ;i;vr4 1c.,a4, /• ��f <r. • ? .1 r•! .. . ":�• +"4iSf'•y