890636.pdfx7.
1
FADDRESS
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION
Q 90� 0OWNER NAME/NAME OF BUSINESS J1 _ N CHECK SUBDIVISIO NO. LID NO.
MAILI
CITY
/hgyp TESCP
v(j� ,vie PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
TELEPHONE NUMBER
�x/�O?/ PROPOSED____REOUIREDDEDICATION__.._.._._
Rion of Property -
or attach two cop
dmo�da ��A v0�
we tied o-40/- E /
R
UMBER
e all easements
LJ NEW LZ%J RESIDENTIAL
C� ADDIALTER COMMERCIAL
❑ REPAIR APT. BLDG.
EXCAVATE
DEMOLISH OR FILL
CARPORT
REMODEL GARAGE
❑ WOOD STOVE ❑ RETAINING WALL/
INSERT ROCKERY
NUMBER OF STORIES NUMBER
DWELLINF
UNITS
er,
L.J PLUMBING
R% MECHANICAL
L J SIGN
FENCE
( x ,/_FT)
I �I SWIMjga46 "
ElRENEWAL
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
METER
:Ik
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
SETBACKS —FEET
FRONT SIDE
SIZE
W
i
3
ENV. REVIEW
COMPLETE I EXEMPT
ING REVIEW BY
DATE
HEIGHT I LOT COVERAGE
REAR
4$TRUCTION I� I
� 88
SPECIAL INSPECTUH ^^�^ ...
REQUIRED GROUP
El YES ': NO
REMARKS
PROGRESS INSPECTIONS PER UBC
NATURE OF WORK TO BE DONE (ATTACH PLOI MAN)
�rl a 7f or
ae/tid l nA uJ f
/v jet&I LZ 33 Lamw. T�/ 3� 000 /f%!/ PLAN CHECK FEE
C �e 1/ 0• , cli J ipu Y.AO/S -` +Ld BUILDING
.' dYt
qr� G/aw Su! vpora�fak� Co„YQ�a/S, /
will ��V¢ .Sevin"/iiod � POO'It /V /Vf"/`� PLUMBING
1�1S¢O 1/ ffa 5 f ggtjt.y T /tAGir 0 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
3 harmless the City of Edmonds, Washington, its officials,
e employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
3 modify, waive or reduce any requirement of any city ordinance
r 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 ATTENTION
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 THIS PERMIT
state laws regulating construction; and in doing the work authoriz• AUTHORIZES
ONLY THE
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa• wNOTED
ti n Insurance. INSPINSPECTION
SIGNAT (OWNER OR AGENT) DATE SIGNE DEPARTMENT
CITY OF
�� � � •�� � �� EDMONDS.��
ATTENTION ''
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUR
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ^
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102.87
OCCUPANT
LOAD
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 SIGNAT DATE/
;�e7 BY
ORIGINAL — File YELLOW — Inspector— File YELLOW — Inspector
PINK — Owner GOLD — Assessor
b.
1 1'
�
r ,
I
I
r
>: wR")AQ!M\AM�^R?y 17•(rM'I..,.i�y
%?.�v'�y'r�+�fii{ld1`r�'7��'^'•` ,
\
i
- I
l
4
i.
/y
r r I
.i
Y;
i1
- i
RECORD OF INSPECTIONS
Date Passed
FOUNDATION
House
Porches, piers
Retaining Halls
Garage, carport
PLUMBING
Underground
Rough•in lr:.
Water service - -
HEATING SYSTEM I1rEt}0k. a
FRAMING
WALLBOARD
CINAL
g9 b�.36�