890518.pdfw
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
USE .�NERMIT
UMBE � OC •Q
ZONE NUMBER y, v
JOB
ADDRESS I 1 30� OI y�Q1 L v) etJ b/`
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. [LID NO
30 L �/ I ��"� vQ• PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
If TELEPHONENUMBER
EXISTING _.. REOUIREDDEDICATION_—
O PROPOSED
IE
Rkwkss Cock N1 RIGHT OF WAY CONSTRUCTION PERMIT REO
)RESS STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO D
/ TELEPHONE NUMBER
N w 4061
O � REMARKS
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METER SIZE
REMARKS
S
ALLOWED
SUPPLY SIZE
AREA
I PROPOSED
OR CU
TESCP
APPROVED BY
ENV. REVIEW
COMPLETE I EXEMPT
T 5 / PQCie ;9(jm FeC�(�S O� �jj-d. SETBACKS -FEET
too FRONT SIDE REAR
�C 1 l REMARKS
r�11
NING REVIEW BY
DATE
HEIGHT I LOT COVERAGE
NEW M RESIDENTIAL PLUMBING
ADDIALTER El COMMERCIAL MECHANICAL
REPAIR APT. BLDG. LJ SIGN
CHECKED BY T E OF CONSTRUCTION CODE
DEMOLISH OR FILL
FENCE x —FT)
; - r
M h )�
CARPORT SWIM SPECIAL D SPECj OR AREA OCCUPANCY REMODEL GARAGE L REQUIR / GROUP
..
❑ WOOD STOVEI RETAINING WALL/ O YES NO Now
•
INSERT ROCKERY RENEWAL MARKS
PRO dRESS INSPECTIONS PER UBC 305
NUMBER OF STORIES NUMBER OF
•-Z DWELLING t
UNITS
NATU OF WORK TO BE DONE ATTACH PLO P )
l iDi a n.
1• � /,,G Iw�t(�Ac Z4 I2ks VALUATION
V" a�cw7 I� PLAN CHECK FEE
• f3S Z ,r 1 k�S Z - 51�a���es - LAvs
BUILDING
17 t PLUMBING '/
y/�II14}I}G/IL L� � 3a
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the pubNC: 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
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
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
Co e o
the tate of Washington relating to Workmen's Compensa•
WORK NOTED
ti n ra Ce
INSPECTION
31 E WN R OR AGENT)
DATE SIGNED
DEPARTMENT
k r CITY OF
21 EDMONDS
A MENTION 771-32oi
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
LOAD
00
• DO
Al of 00 F°soil
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 SIGNATURE DATE
RELEWftr5�B`Y � GATE
�1
ORIGINAL — Fi e YELLOW — Inspector
PINK — Owner GOLD — Assessor
R
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,•+... RECORD OF INSPECTIONS
Date Passed
9;01INnATION
House
Pc)rrh-�s+ piers
R,ataining wells
Garrve• carport
OLUMBiNG
Underground
Rough•in
water service
HEATING SYSTEM
FRAMING
WALMARD
FINAL