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USE CITY OF EDMONDS ZONE PERMIT
NUMBER
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CONSTRUCTION PERMIT APPLICATION
OWN NAVE/NAME PF BUSINESS.,JOB
(\J ADDRESS /i1' SUIT PT kCc
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n v LEGAL DESCRIPTION CHECK SUBDIVISIO Z M ILING ADDRESS N0. LID N0.
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CITY ZIP TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, TESCP
EXISTING APPROVED BY
08 REQUIRED DEDICATION
NAME PROPOSED _
C7
~ D 0 Z w RIGHT OF WAY CONSTRUCTION PERMIT REQUIREADDRESS �
�- STREET USE PERMIT REQUIRED ❑ "J
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SEE ENGINEERING MEMO DATED REVIEW BY a
a CITY ZIP TELEPHONE NUMBER Z
w
NAM
REMARKS
ADDRESS
U METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
cE CITY
r / % ZIP TELEPHONE NUMBER
G 3S l REMARKS w
Occ
STATE LICENSE NUMBER a
s` SIGN AREA ENV. REVIEW
ADB NO.
Legal Description of Property -include all easements ALLOWED PROPOSED COMPLETE EXEMPT
Z (show below or attach two copies) I
9 <
t.1
Tax Account Parcel No.
L-1 NEW 14z- RESIDENTIAL
ADD/ALTER El COMMERCIAL
REPAIR F1 APT. BLDG.
ElEXCAVATE, FILL
DEMOLISH OR GRADE
REMODEL CARPORT
GARAGE
❑ WOOD STOVE ❑ RETAINING WALL/
INSERT ROCKERY
YPE.OF USE, BPSJNESS OR ACTIVITY) EXPLA
NUMBER OF STORIES
NAVE OF WORK TO BE
NUMBER OF
DWELLING
UNITS
(ATTACH PLOT PLAN)
PLUMBING
n� MECHANICAL
I— J SIGN
❑FENCE
( x_FT)
M SWIM
RENEWAL
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
ECKED BY ITYPE
PLANNING REVIEW BY
REAR
DATE
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR AREA OCCUPANCY
REQUIRED GROUP
CJ YES G NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
lf'I �.
t,.J4 No. y i
STATE SURCHARGE
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il`i`• •r limit in any the • • • • ordinance
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L AMOUNT DUE
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FEE
LLOADPANT I I I.'11
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,
FIC S GNATURE ATE
.EASE BY: DATE
ORIGINAL
— File
YELLOW
— Inspector
PINK —
Owner
GOLD —
Assessor