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USE PERMIT
CITY OF EDMONDS ZONE NUMBER -
CONSTRUCTION PERMIT APPLICATION SOB SUITE/APT# I3
OWNER NAMEMMIE`OF•BOSffJESS
MAILING ADDRESS
CITY OIZIP TELEPHONE NUMBER
NAME
ADDRESS
TELEPHONE NUMBER
NAME ,
rip
ADDRESS
i
CITY �, ZIP TELEPHONE NUMBER
03
ST TE LICENSE NUMBER
J/1&'/ C7 R� 1) 3
Legal Description of Property - include all easements
(show below or attach two copies)
Tax Account Parcel No.
CJ NEW RESIDENTIAL I�j PLU E RP
rZ
ADDIALTER COMMERCIAL ME H IN
PI r I REPAIR APT. BLDG. SIGNEj EXCAVATE, {{'�>�
CJ`etl
FILL
DEMOLISH OR GRADE ❑ (ENCE
x—
❑ CARPORT swim
REMODEL L..j GARAGE L.J POOL
IF WOO SERT ❑ ROCKERYRETAININ
WALL/ ❑ RENEWAL
Z
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CL
Fr
w NUMBER OF STORIES NUMBER OF
p p� / e DWELLING
co� UNITS /Y
NATURE OF WORK,TO BE DONE (ATTACH PLOT PLAN)
75
h /
/A /0 r
ADDRESS , 6
:EGAL DESCRIPTION CHECK SUBDIVISION NO. v LID NO. ICI
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION - - --
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED O
STREET USE PERMIT REQUIRED O
SEE ENGINEERING MEMO DATEDREVIEW BY,
SIZE ]BUILDING, SUPPLY SIZE
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE #
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKSri
® LOT COTERAGE
FRONT •
;F ECKED BY TYPE
S\O/Fp`CONSTRUCTION uuue/
OWlll
Olt I
SPECIAL' II)IS`P14CTOR AREA JOCCUPANCY
REQUIRED Ne.,, GROUP
YES iU}O
REMARKS NIN
PROGRESS INSPECTIONS PER USC 305
i
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
l NG
[�PA/aft? Lt1 iC/(`('V i��/'% '/ PLUMBI
Plan Check NO. MECHANICAL
This Permit covers work to • e done on private property ONLY. dRADINGIFILL
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 &( s br Rer bp`duse, heirs, assign 1 —
too successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
cc 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 acknow ledg�q at, I%glaJQread ti ffs application; that the'. �~-ytTTENTION
information given is correct; and that I am the owner, or the dilly
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 WONLY--WERK
Code of the State of Washington relating to Workmen's Compensa
tl0 insurance.'A�O INSPECT NII``
SIGNATU ER(OW R OR AGE T) f DATE SIGNED DEPARTM�NJf�
/�C
'CAL�.—h'
;A.,
aov
HEIGHT
OCCUPANT
LOAD
APPLICATION APPROVAL
This application is not a Kermit u�iil
sined b* ll�e�Bku Ding Qfl iab 01G h1�
Duty; a d fees are paid, an receipt is
acknowledged in space provided.
OFNFI�CYFS IGN/D
A RE'' A
' .� All t
ATT E NTI O $P'ECLT_ION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE .7_%02— (Ft
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORO ORIGINAL \\
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Own
102.87
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`- DATE
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YELLOW — Inspector j
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GOLD — Assessor
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