910225.pdfP
USE F PERMIT i
7NA
ITY OF EDMONDS ZONE NUMBER �_02
CTION PERMIT APPLICATION JOB �, �_ SUITE/APTIt
OOF 8�\SINESQ\ _ ADDRESS `
GiLEGAL DESCRIPTION CHECK SUBDIVISION NO. LIDNO.
w MA '
CP
O ` �- j PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. AppROVED BY 11
CITY ZIP TELEPHONE NUMBER
�A., I t I 1 EXISTING REQUIRED DEDICATION `l{t TELEPHONE PROPOSED
NAME
Ec
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED ❑ w
I
w
L) STREET USE PERMIT REQUIRED ❑ Z
w ADDRESS z I.
REVIEW BY w
x SEE ENGINEERING MEMO DATED
Cr O CITY ZIP TELEPHONE NUMBER
REMARKS
NAME it\ ID �'" T _`/��
ADDREX
O METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
?r. CIyY-��/�•fJ1�911ZIP� T NE NUMBER Q
REMARKS 3
STATE LICENSE NUMBER
IVOAF/r war /t)3 -
Legal Description of Property - include all easements
(show below or attach two copies)
Tax Account Parcel No,
LJ NEW RESIDENTIAL
ADDIALTER COMMERCIAL
ElREPAIR APT. BLDG.
EXCAVATE, FILL
DEMOLISH OR GRADE
CARPORT
REMODEL GARAGE
I� �I WOOD STOVE/ ❑ RETAINING WALL/
' I INSERT ROCKERY
TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
N URE OF OR j BE DONE (ATTACH PLOT
i W
lJ PLUMBING
MECHANICAL
LJ SIGN
FENCE
( x _FT)
r l SWIM
ElRENEWAL
SIGN
AREA
ENV.
REVIEW
ALLOWED
I PROPOSED
COMPLETE
I EXEMPT
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
CHECKED BY
REAR
TYPE OF CONS
REVIEW BY
ADB NO.
DATE
HEIGHT I LOT COVERAGE
I;
[SR
PECIALINSPECTOR AREA OCCUPANCY OCCUPANT
EQUIRED GROUP 1% LOAD
❑ YES : NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
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 Ch��
Permit Limit: 1 Year- Provided Worls is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and T
u, successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
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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
° nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby ackn edg that I have read this application; that the ATTENTION
information en is cor ect; and that I am the owner, or the duly
authorized ent of th ow er. I agree to comply with city and THIS PERMIT
state laws r gulating c tr ction; and in doing the work authoriz- AUTHORIZES
ed thereby no perso 111 a employed in violation of the Labor ONLY THE
Code of the State o a hi gton relating to Workmen's Compensa WORK NOTED
tion Insura Ce. INSPECTION
SIGNATURE 3 ER OR A DATA SI NED DEPARTMENT
, 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•
10287
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.
LEAS
TE
/� SIGNATURE 4/�A
E
0
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assesso/
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