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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
J'(1 n G_ T/'j11P 1 AIV-7 IAYI v
a►$0 qtj 0 E. I g51h
E NUME
-3)
USE PERMIT
ZONE ��� I NUMBERJOB
ADDRESS OQ D/ be � /M O / /j V I Gto ✓/i
.EGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
to/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
,nn APPROVED BY
EXISTING �__ REQUIRED DEDICATION, —
PROPOSED ."__-_ V
t t /� Z
1C 6 LREMARKS
CONSTRUCTION PERMIT REQUIRED W
ADDRESS Q / , RMIT REQUIRED. _
C u t 1v ING MEMO DATED G R VI Y
CITY TELEP NE NUMBER 0l 1
S+� 30 NCook Consf� o/) i�M'. �A /RRESS AQ' /b��✓�1/'✓f1 ZA6AeGT!ONS
�b iI IZ 1e& I I Ue • S E METEFjSI E + ( BUILDING )YPPLY SIZE FIXTURE UNITS
CITY TE►L')EP ONE NUMBER / /S
/ � V�:E63 DS7� REMAR o'/ S 3
STATE LICENSE NUMBER `/� �/ �� t
U0ea ** Ca / ib t SIGN AREA ENV. REVIEW ADB No.
Legal Description of Property - include all easements ALLOWED PROPOSE COMPLETE EXEMPT
(Show below or attach two Copies) SHORELINES
,/) S VAR IC:740 /Anio� h 0 V6 qiom, OR_C,U 04 PLANNIN REVIEW Y DATE
`— / 7GC . IT, / ra7J SETBACKS -- FEET to HEIGHT LOT COVERAGE
(f�7 N �
FRONT M SIDE /O, REAR V ZS/ /
t 006 0 02 � 0003 M 0
/IS 28 8
NEW RESIDENTIAL PLUMBING ,
ADDIALTER COMMERCIAL F1 MECHANICAL
REPAIR APT. BLDG. SIGN
EXCAVATE FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT /
DEMOLISH OR FILL I. x_FT) WSA '�� , IgT 25
CARPORT ❑ SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REMODEL GARAGE POOL REQUIRED GROUP ^
' V LOAD
WOO SERTVEI II " NO
ROCKERY RENEWAL
WALL/ RENEWAL REMARKS
PROGRESS INSPECTIONS PER UBC 305 a
'I an C ke. dk # lob _ �p,� =
NUMBER OF STORIES NUMBER OF %11£�Ci11/¢G 17VSc l ?Yb Of 6Y CODE
DWELLING
UNITS
NATURE OF WORK TO BE {/D.��ONNEE 7 `j(ATTACH
PLOT PLAN)
S1NV•1LRKF4 IL F5 •
PLAN CHECK FEE
ouiwiriG
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
successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
i
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
i 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
tl n Insurance. INSPECTION
SIG T RE (OWNE OR AGENT) DATE SIGNED DEPARTMENT
a.�� 5-30-ff9 CITY OF
EDMONDS
ATTENTION 771"32;00
I
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
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,
OFFICIAL'S SIGNAZORE DATE
W. 1
ze/rd
ASED BY: DATE p
ORIGINAL — File YELLOW — Inspector l
V ✓
PINK —Owner GOLD —Assessor
l
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��tJ ,. � .:__xu_.„.L_..ay..-_.,1.r_.1.,�.i.c�.d.S�.Lta._�?..:dre.....::(d: i,.�..a...�>..,xu.._:+' v..�.,.. _...�.•
Date Sent to Engineering o
ENGINEERING APPROVAL FOR OCCUPANCY
MEMO T0: Permit Coordinator I AS
Building Division
FROM: Dan Smith
Engineering Inspector
DATE: //� / ( 4 �
Ile
SUBJECT ADDRESS:
PERMIT#
SUBJECT NAME: �/Z—`S�
I, PERMIT APPROVED FOR FINAL
II.[] PERMIT NOT APPROVED FOR FINAL
Requirements:
1.
2.
3.
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RECORD OF INSPECTIONS
Date_ Passed
FOUNDATION
House
Porches, pi
Retaining v
Gara4,p, cat
PLUMBING
Undergr4ur
Rough•in
Water servi
HEATING SYS7
FRAMING
WALLBOARD
FINAL.
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