890257.pdf- .- . - ---
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW AME/NAME OF BUS SS
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MAILING ADDRESS
12,33
CITY
CITY
STATE
below or attach
L.J NEW IJ RESIDENTIAL
ADDIALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
WOOD STOVE/ r7 RETAINING WALL/
INSERT ROCKERY
NUMBER OF
4v,
NUMBER 0
DWELLING
UNITS
ZIS1
NUMBER
NUMBER
USE PERMIT
ZONE 15111 NUMBER 990257
JOB ; o/ymelc.
ADDRESS ��
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. ITESCP
APPROVED BY
EXISTING REQUIRED DEDICATION_.__
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
STREET USE PERMIT REQUIRED:
SEE ENGINEERING MEMO DATED
METER SIZE
REMARKS
SIGN AREA
easements ALLOWED PROPOSED
PLUMBING
1:1 MECHANICAL
L_J SIGN
FENCE
x _FT)
f—1 SWIM
RENEWAL
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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."
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 person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
DATE SIGNED
4 1103) et,
ATTENTION
VARIANCE OR CU
SETBACKS - FEET
FRONT SIDE
UNITS
COMPLETE i EXEMPT
REAR
A
TYPE OF CONSTI
4(
REVIEW BY
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR AREA OCCUP
REQUIRED GROUP
❑ YES L: NO
" J I LOAD
PROGRESS INSPECTIONS PER UBC 305
Mwm
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENERGY CODE
5/6/✓
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
771=3202
R
Z
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.
NATURE / PATE
DATE
ORIGINAL
— File
YELLOW
— Inspecto
PINK —
Owner
GOLD —
Assessor %
1\
SENT TO PLANNING '// %led?
PLANNING FINAL APPROVAL FORM
MEMO TO: Jeannine L. Graf, Permit Coordinator
FROM: Leigh Francis, Associate City Planner
DATE, p�
PROJECT: 4W /�L�/'9LTL -s
ADDRESS. /2 3 3 D/yvwv/i- l &Al A/
ADB #: q 89 PERMIT 025?
PERMIT APPROVED FOR FINAL
PERMIT NOT APPROVED REQUIREMENTS:
1.
�I
�q
Leigh FrancisDa-te14
Associate City Planner
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RE_CQ_RD OF INSPIT�_ IONS
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FOUNDATION
House
Porches, Piers
Retaining walls
Garage, Carport
Pi I IMSING
Underground
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Water serviet
NEATiNG SYSTEM
FRAMiNG
WALLBOARD
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