900712.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ZIP TELEPHONE NUMBER
60,740S l��v 7 7 - f3 7y
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TELEPHONE NUMBER
USE PERMIT
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LEGAL DESCRIPTION (CH,/ECGKK SUBDIVISIONNO.NjO.. / (,LAID NO,
AV
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING _ REQUIRED DEDICATION
PROPOSEDI'•'�
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED O
STREET USE PERMIT REQUIRED ❑
SEE ENGINEERING MEMO DATED �
REMARKS
per ,
ER SIZE
REMARKS
UP I
SUPPLY SIZ
SIGN AREA
ALLOWED PROPOSED
_egal Description of Property - inclu a all easements
show below at ch two pies) Sf tT /3 7�JdZ7
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r 0 �0i • S CVARIANCE OR CU
R8 /' 3/ n gCOqr' SA/H CQS E' �b SETBACKS - FEETSol S2-'l DOG /oo %C70 d K FRONT SIDE
DOW Tax Account Pace No. Lim REMARKS
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LJ NEW L&I RESIDENTIAL LJ PLUMBING
9 ADDIALTER I� COMMERCIAL MECHANICAL
ElREPAIR APT. BLDG. SIGN
EXCAVATE, El DEMOLISH OR GRADE FILL ❑ I. PENCE x _FT)
CARPORT SWIM
REMODEL 5d GARAGE El POOL
❑ WOOD
ER STOVE/ ❑ RETAININROCKERY G WALL/ RENEWAL
(TYP OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
A2A6Eo Fog leESiDErJG.
NUMBER OF STORIES NUMBER OF ���
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Am
ENV. REVIEW
COMPLETE I EXEMPT
UNITS
ITE/APT N
PL NNING REVIEW BY I DATE
HEIGHT LOT COVERAGE
v REARZ6 Z0
SPECIAL INSPECTOR AHEA UUUUVANUT ^ -
REQUIRED GROUP I(wz
YES t:; NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
A A 6 61 E FINAL INSPECTION REQUIRED
VALUATION
g�>2UL� >�1RA2. �' ALtMLAZi�f�S b� : PLAN CHECK FEE
a vv%-erns Y3. V h F BUILDING % O 99 j
(, lK4 wo 4570tvas 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,
memployees, and agents from any and all claims for damages of
z 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
o 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
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
tion Insurance. INSPECTION
SIGNATURE (OWN OR AGENTI DATE IGNED DEPARTMENT
Z L q CITY OF
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
G
HEIGHT
2.S�'
OCCUPANT
LOAD
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy�nd fee re paid, nd receipt is
ackno (edge pa vided.
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•SETBACKS � _—` �a • � • � e .. , ' . ;
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Footing.
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+ Pier/Porch .............
Retaining Wall.
PLUMBING: —$;P
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HEATING:
Gas Test.
Gas Piping ....... I .... .
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Equipment ............ .
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FRAMING .I............----^� �•+
SHEETROCK NAILING
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SPECIAL INSPECTION t
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'FINAL APPROVAL
FOR OCCUPANCY ......
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