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900859 (2).pdf
K ■ CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME S MAILING ADDRESS / �© /yJ 1, / IP aU ,Q P CITY� ZIP TELEPHONE NUMBER � NAME NUMBER eeU/CPI' AC, o a ZIP TELEPHONE NUMBER H CITY O STATE LICENSE NUMBER Legal Description of Property - include all easements U s (show below or attach two copies) Tax Account Parcel No. USE PERMIT ZONE NUMBER JOB Obl OZ �VA4PIG ADDRESS cant nFSCRIPTION nHECKI SUBDIVISION NO. ILIU NO. TESCP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY EXISTING REQUIRED DEDICATION PROPOSED RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑ STREET USE PERMIT REQUIRED ❑ REVIE SEE ENGINEERING MEMO DATED REMARKS IJ METER SIZE BUILDING SUPPLY SIZE FIXTURE UNIT, a cc LU / REMARKS 3 SIGN ARE& ENV. REVIEW ADB NO. ALLOWED PROPOSED COMPLETE EXEMPT I I SHORELINE# VARIANCE OR CU REVIEW BY DATE SETBACKS —FEE T HEIGHT LOT COVERAGE FRONT SIDE REAR REMARKS LJ NEW RESIDENTIAL " PLUMBING ADDDDIALTER COMMERCIAL MECHANICAL REPAIR APT. BLDG. SIGN CH FILL PENCE DEMOLISH OR GRADE ❑I. x—FT) TYPE OF CON5THUG7I W6190 CARPORT . ❑ SWIM SPECIAL INSPECTOR AREA UULoUrANLoT REMODEL GARAGE POOL W00 INSERTVE/ ❑ ROCKERYRETAININWALL/ ❑ RENEWAL (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER OF STORIES N MBER OF ofie DWELLING O �/d /l� c UNITS �r (..� NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) �/06 2 -iDl5 i S 6ui AT /N 1 v '�/PP Z ce , 1p:11yJuve Af1C IF '_// //-- l % PLAN CHECK FEE ALo�� kt jQ1 ant or Tl�9� Ile rl CY 1A,1 BUILDING y� pq/Z., PLUMBING Plan Check NO. MECHANICAL This Permit covers work to be done on private property ONLY. GRADING/FILL 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 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 PLAN CHECK DEPOSIT 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 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 Code of the State of Washington relating to Workmen's Compensa• WORK NOTED tion Insurance. INSPECTION SIGNATUR (OWNR OR AG T) DATE SIGNED DEPARTMENT CITY OF EDMONDS CALL FOR ATTENTIO INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202 UNTIL A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC CHAPTER 3, 102.87 REQUIRED I GROUP n YES CJ NO REMARKS PROGRESS INSPECTIONS PER UBC 305 FINAL INSPECTION REQUIRED VALUATION 000 I 5 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. OFFI 'S IGNAT 1/1140je76 w ELEASED DATE ll� ORIGINAL — File YELLOW — Inspector )?;. PINK — Owner GOLD — Assessor tI