910369.pdf1
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
NAILING ADOR SS
�cv 01
CIT
DAME
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBE
Legal Description c
Ivl �L r:�J
C ZIP TEEL]EPHON PH
l 1 / 1
ZIP ITEL
rLr
USE PERMIT �'
y.•
, r'
ZONE NUMBER �� '
L0 90
JOB //� �I %� ►/ n SUI /APT N
ADDRESS
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. ILID NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
.ER
2 � ;J EXISTING REQUIRED DEDICATION
�(J( PROPOSED
REMARKS
NUMBER
ZIP I TELEPHONE NUMBER
roperty - include all easements
Tax Account Parcel No.
NEW RESIDENTIAL CI PLUMBING
ADD/ALTER El COMMERCIAL MECHANICAL
REPAIR El APT. BLDG. El SIGN
ElDEMOLISH El GRADING CYOS. (ENCE x—FT)
CARPORT swim
REMODEL GARAGEPOOL.
WOOD STOVE/ ❑ RETAINING WALL/ ElINSERT ROCKERY RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES-. NUMBER OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
ENGINEERING MEMO DATED
SIZE
REMARKS
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
BY ►TYPE OF
PPLY SIZE I NO.
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
REVIEW BY
SEPA REVIEW I ADB N
COMPLETE (EXEMPT
SHORELINE
EXP
PLANNING REVIEW BY DATE
IT: ".0
HEIGHT I LOT COVERAGE
SPECIAL INSPECTOR I AREA I OCCUPANCY
REQUIRED GROUP
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FEE
HEIGHT
OCCUPANT
LOAD
2
w
a
:?
t7
z
E
z
5
EL
t;PLAN CHECK FEE
(i E • '
Plan Check No.
STATE SURCHARGE
tiPermit Application: r Days
•
9��� _ '....
DRAINAGEPermit w I Year Provided Work Is Started 180
• 3 p �"T�
{
nor limit in TOTAL AMOUNT DUE
t'
• • • • • • • • • • • •
i•
--
,1 provision. 5 .�., via :�,., a s�•..,. .
APPLICATION APPROV
Ifr • • • • • : • • : • j?
• •• .•: • iCiThis applicationnot permit
signed by the Building Official or his/her
aid; : • • • • • • • • • • fi •'
'I;. j3 •' • • • • and fees are paid,
acknowledged in space pr 6d.
I • Insurance.s` •
DATE SIGNED
„t 1 • •
n lei � • � ��
Ll
, I / 7 �
d, any;, .1 a..u, x,.` •}. , s,rl u,, F..N i.r„P ,'i 15,..4.,�<,A! . �95.�.7? � s 1. s lizk., _ Mir
PIZ
���/
.rr'. ..r ._..,,.,. ..._...-.... ..-...r:Z•/^ �1«r. *"•TIr. �S ""��';lr.•�, 'S'T'l T.' ";tiS'"'SfTr'�1" `�T(r'^';�y�'ir.�•r^F.'T�m.,y.1 �i�'ne•rp:lt•T�—��•`Sy'+r}w.rT^G7'e+^ 'i.. •ii+i,.+� .. .1
f\4�4