900022.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAM AME OF BUSINESS
MAILING ADDRESS
'1. G
NAME
U/ lV0DD
NAA E
ADDRESS
1
ADDRESS
31 �
'beff
STATE LICENSE NUMI
TELEPHONE Nl
?I; 0 67A-
ONE
USE PERMIT
ZONE NUMBER
JOB 16 310
ADDRESS
.77A, nccro�DrinN CHFCKI. ItinnIVISION NO
U5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED
�vr eat �►
VPa# 14A 1) W y METER SIZE BUILDING SUPPLY
ZIP I`T Th3-53--U3ias
REMARKS
Legal Description of Property - inc
(show below or attach two copies)
Tax Account Parcel No.
all easements
LJ NEW LJ RESIDENTIAL
ADDIALTER COMMERCIAL
REPAIR APT. BLDG.
EXCAVATE, FILL
DEMOLISH OR GRADE
CARPORT
REMODEL GARAGE
❑ WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY JOOOO
(TYPE OF USE, BUSINESS OR ACTIVITY) �(PLF
NUMBER OF STORIES NUMtMrrr
DWELLING
UNITS
NATURE OF WORK TO
tl Colvoz
Pf%661 2S(�
�jt�fp/t(
PLUMBING
MECHANICAL
n
LJ SIGN
❑FENCE
I. x _FT)
I —I SWIM
11 RENEWAL
UNITS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE N
VARIANCE OR CU PLANNING REVIEW BY DATE
HEIGHT LOT COVERAGE
SETBACKS - FEET z
Z
FRONT SIDE REAR g
REMA KS a
S/ 6e 4ee
BY ITY
38
SPECIAL INSPECTOR I AhrAl ���� . I• / OCCUPANT
REQUIRED I GROUP LOAD
n YES U, NO
REMARKS
PROGRESS INSPECTIONS PER UB jC 305
7 v°rr®jnA o I "0jo0 / rL /lit
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check NO. 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
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
m successors in interest, agrees to Indemnify, defend and hold
W harmless the City of Edmonds, Washington, Its officials,
2 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
o modify, waive or reduce any requirement of any city ordinance TOTAL AMOUNT DUE
° 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 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• LITHO IZ THE
violation of the LaboONLY
Code of the State of Washington reled thereby, no person will be lating ton Workmen's Compensar WORK NOTED
tion Insurance. INSPECTION
SIGNATURE IOW O GENT) DATE SIGNED DEPARTMENT
0 1 r 9U CITY OF
QT EDMONDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771=3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102.87
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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.
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessoj/or
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RECORD OF INSPECTIONS
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HEATING:
Gas Test. I I I r ,.
Gas Piping .•••••••••.
Equipment • • • 0 a • ..
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44
FRAMING ...............
SHEETROCK NAILING .. .
SPECIAL INSPECTION • . .
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FINAL APPROVAL r I k
FOR OCCUPANCY .......
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