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" USE PERMIT
CITY OF EDMON DS ZONE jpet_) Z NUMBER 890
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS �+
To SEPH l 14) W 0
MAILING ADDRESS
1 19A-dt.yflP16 M 6a.
CITY T LEPH NE NUMBER
Ehm () s 2� 718 f y36 y
NAME
ADDRESS
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)escription of Property - include all easements
below or attach two copies)
417-IE of Treat v.,
tFOMlvAros sly Y/el* 74IL7 '
LJ NEW RESIDENTIAL
ADDIALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
WOOD STOVE/ r7 RETAINING WALL/
INSERT ROCKERY
NUMBER OF STORIES NUMBER 0
DWELLING
(J�V UNITS
/L. OD
VS tv), ,lams
9
W�Snm EitJ T
LJ PLUMBING
F1MECHANICAL
L_ J SIGN
FENCE
I. x _FT)
RENEWAL
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
I 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."
hereby acknowledge that I have read this application; that the
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ADDRESS /��Z9 O/Yin�iG Y��✓�i21tvE
LEGAL DESCRIPTION CHECKI SUBDIVISION NO ILID Nn
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. I TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION. _—_
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED.
SEE ENGINEERING MEMO DATED
METER SIZE IBUILDING
SIGN
AREA
ENV.
REVIEW
ALLOWED
I PROPOSED
I COMPLETE
i EXEMPT
0
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS - FEET tHEIgHT LOT COVERAdIfFRONT 2 ' !SIDE IO' REAR 2
z+
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP R 3 LOAD
❑ YES ':NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
%loWn
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE I I �'7 c"fl VDr1
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
ti n Insurance. INSPECTION
SIGNATUR (OWNER OR AGENT) DATE SIGNED DEPARTMENT
% 7/ J� 4'9 CITY OF
Lee EDMONDS
AT NTION 771"3202
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 SIGNATU DATE
D BY:
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ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor {
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RECORD OF INSPECTIONS
a� Y� FOUNDATION
House
Porches, Pil
r� Retaining w
/J/ Garage, car
�f� PLUMBING
Undergrour
Rough•in
�0 Water sery
HEATING SYS7
FRAMING
WALLBOARD,
FINAL
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