910176.pdfUSE PERMIT �. F
t CITY OF EDMONDS ZONE 5�/20NUMBER
- :Olt
L76 ; Id
CONSTRUCTION PERMIT APPLICATION �oB (, SUITE/APT# �,'
OWNER NAME/NAME-OFBUSINESS--g ADDRESS
CN�R��S hFlIQ G� J�� ►/1/t V t�w
MoQ HAW FAr LEGAL DESCRIPTION CHECK SUBDIVI N NO. LID NO.
i
F h0 - • A -
ZMAILING ADDRESS TESCP
0 9111 CY.V V I LJ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY
CITY ZIP TELEPHONE NUMBER
is) K:.'I -I c., O li !i 0 EXISTING REQUIRED DEDICATION
IFIDMON WIR . Ho: 77 `I SP01 I PROPOSED 0
NAME z
O RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑ w
F I A L 6 F N ON STREET USE PERMIT REQUIRED ❑ z
w ADDRESS Z
F REVIEW BY w
U 5�10 I Z SLJTj Z0,3 SEE ENGINEERING MEMO DATED
CITY ZIP TELEPHONE NUMBER
If MOUNT LP IKE TERRAC %64113 'J 7 b 0 REMARKS
NAME
GN E FAQ 0.
Cc ADDRESS
METER SIZE BUILDING SUPPLY SIZEIF Cr
FIXTURE UNITS
goy a sw M 6
Q CITY
ZIP TELEPHONE NUMBER 4
REMARKS
O A TER2twE y Dy3 �� l
U Ma
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO.
MT F M TrIOKIT ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements SHORELINE#
(show below or attach two copies)
z
0
a VARIANCE OY P3A
U
w Z
SETBACKS -FEET HEIGHT LOT COVERAGE
J - , f,,y/[�� �7 �� Z
wFRONT'2-� SIDE V REAR I' -`� g
REMARKS 'L� / a
Tax Account Parcel No. /r Z `7D � Vvj� c,
/ZoNEW RESIDENTIAL El PLUMBING12
^
/t l
DD ALTER COMMERCIAL 17 MECHANICAL
REPAIR APT. BLDG, El SIGN
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
EXCAVATE, FILL FENCE
DEMOLISH OR GRADE — ( x FT)
CARPORT SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
® REMODEL Lj GARAGE
F WOOD STOVE/ ❑ RETAINING WALL/
INSERT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
, VITI GSE. 'Bn MElV7 r
NUMBER OF STORIES NUMBER OF
NATURE OF WORK TO BE
DWELLING
UNITS KIA
(ATTACH PLOT PLAN)
cFMe-/VT 'AE
nl
POOL REQUIRED GROUP /<4z LOAD
❑ YES C; NO
ElRENEWAL REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
A I NC p N D ,vl Ca ILD".c BUILDING
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 Worl 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
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 CHE
0CK DEPOSIT
of this permit, Issuance of this permit shall not be deemed to
0 modify, waive or reduce any requirement of any city ordinance
°x 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 I Ur, ce. INSPECTION
SIG AT OWNER OR A Er T) DATE SIGNED DEPARTMENT
r CITY OF
EDMONDS
HIM 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
FEE
,y
� N
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.
OFFICI SI NATURE � DAjE�
( ELEA _ DA JE
' // 11L J G e
ORIGINAL — File YELLOW — Inspector— File YELLOW — Inspector
PINK — Owner GOLD — Assessor
:I
r _.
:
j
b ;
L - �
t'
�! � IT
i5( y� r'b11 1 f !�,
nJII Is,
r It •"
ti �.� it'r tr an°� rail's, S,c}v
vq
f,
1i rtt tr
IV
.,
mqq
:
IN
Nt Vote ,r•. .
{t
No
VV`eNN IN
IN
. .
..L k kI aNl
..d
. ,
..
„'. + ,IN L
1
s _
i
G RECORD OF INSPECTIONS
INSPECTOR L DATE APPROVED
I NIP i,":
�.
SETBACKS.. `'
.
PL
I FOUNDATION:
i Footing :.............. .
t _
f- Wall... �. R
IN
_ _ �' ~
Pier/Porch ...IN
'..'e. Retaining Wall.....1':'. .
IN VIV
PLUMBING:
Underground
Rough -In ....
IN CF'..
HEATING: .IN ILI
1 Gas Test.
_ I
r.
Gas Piping ....... 1 1 6 0 1 a
_
r Equipment.
j �]°"�' FRAMING _
SHEETROCK NAILING .. .
SPECIAL INSPECTION
r IN IN
�^-
FINAL APPROVAL�� �D ��IIN
FOR OCCUPANCY .....:.A .
Ol✓%✓P/G ail//GG /�I/JT14GG �S/YIE CT%c S"
3. OwA1,vY/4U,ow' uwr IN"%�,� su-✓,eon VVI
a .
If IN
�r'IN
iy
i�/��
�- Y Bd�2 lll/ ��von. M • 2
5. Ors/ ra/teeIN
IN IV.
r