890141.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
V7 ,
CITY
NAME
I'd
STATE LICENSE NUMBER
C2• 33/12/14_,3
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G
USE PERMIT
ZONE NUMBER
^ NUMBER
JOB /413t3 04PIP�C. Y/fW ,bye
ADDRESS
10r.
EPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED- -
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
NUMBER
FREMARKS7
TELEPHONE NUMBER
JC' 1 • 41)4Q
include all easements
ILDING
SIGN AREA
ALLOWED i PROPOSED
Y SIZE
LID
TESCP
APPROVED BY
ENV. REVIEW
COMPLETE I EXEMPT
TVARIANCE OR CU PLAN ING REVI W BY
DS t� HEIG
FP
U NEW RESIDENTIAL LJ1l PLUMBING
® ADDIALTER COMMERCIAL Cl MECHANICAL
n
® REPAIR RETAINING WALL LJ SIGN
EXCAVADEMOLISH OR FILL TE PENCE ❑ x—FT)
❑ PRE -MOVE INSP.1 ❑ SWIM
REMODEL COMPLIANCE INSP. POOL
WOO INSERT APT. BLDG RENEWAL
�rok 20
UMBER OF STORIES NUMBER OF
�y DWELLING /
UNITS
WORK TO BE DONE (ATTACH PLOT PLAN)
"A/n 7T. I rioe .4,A r
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 Worlt 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
1 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."
I hereby acknowledge that I have read this application; that the
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
state laws regulating construction; and in doing the work authoriz-
ed thereby, no pbrson will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
tion Insurance_
MRE4OWNER OR AGEOT))
FRONT ?.S' SIDE /0'* REAR ZS� 1245
REVI
UNITS
SHORELINE 11
V20M89
TE
ryoki.
LOT COVERAGE
37 M
' SPECIAL INSPECTOR IAREA APANT
REQUIRED GROUP�.LOAD
NO���I�I
PROGRESS INSPECTIONS PER UBC 305
aZ4(14WV ?WCT,C1✓
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE ( I 3 4"
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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•B7
ATTENTION APPLICATION APPROVAL
THIS PERMIT AUTHORIZES This application is not a permit until
ONLY THE signed by the Building Official or his
WORK NOTED Deputy; and fees are paid, and receipt is
INSPECTION acknowledged in space provided.
DEPARTMENT
CITY OF OFFICIAL'S IG TUREew DATE
EDMONDS
D BY: Al
771=3 /., ..,yEr
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor
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RECORD OF INSPECTIONS
Date passed
FOUNDATION w
House 1
Porches, piers I
Retainin:; wells
GaraPe, carport
PLUMBING
Unclerkround ,
Rough -in
Water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL