910418.pdfhEv
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION ,GBADDRESS f — 7� / //) / SUITE/APTN
O R NAN1G/NAME BUSI(�NESS 1\
LEGAL DESCRI✓ / ``
PTION CHECK SUBDIVISION NO..
LID NO.
TESCP (.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. APPROVED BY l
b'�)
r- include
or
IE NUM ER
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EXISTING REQUIRED DEDICATION -
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 1=
STREET USE PERMIT REQUIRED ❑
REVII
SEE ENGINEERING MEMO DATED
Tax Account Parcel No.
O.E.
ESIDENTIAL
PLUMBING
ElADD/ALTEROMMERCIAL
FFO-1
(LJ
MECHANICAL
REPAIR
BIDG.
(L.n.1'
SIGN
IPT.
DEMOLISH CI OR GRADE FILL
❑
FENCE x_FT)
T
REMODEL ED GARAGE
POIN OL
❑ WO INSERTVEt ❑ FIETAINiNDOCKE YG WALL/
❑
RENEWAL
'.. (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES .WELBLINGF
UNITS
ADD
ALLOWED I PROPOSED ( COMPLETE I EXEMPT
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS — FEET HEIGHT LOT COVERAGE
FRONT SIDE REAR
REMARKS
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGH'
1'
SPECIAL INSPECTOR AREA OCCUPANCY Occur
REQUIRED GROUP LOAD
❑ YES Ll NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
aa'`t3 c FINAL INSPECTION REQUIRED
61
� A , � ` � (�f/Ay �� jai �` VALUATION
lY-'" Ill Gl PLAN CHECK FEE
PLUMBING
MECHANICAL
'—'
I G^
Plan Check NO.
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
separate permission. STATE SURCHARGE
driveways, marquees, etc.) will require
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
IOc�
!
"Applicant, on behalf of his or her spouse, heirs, assigns and
in interest, agrees to indemnify, defend and hold
successors
harmless the City of Edmonds, Washington, Its officials,
from any and all claims for damages of
employees, and agents
whatever nature, arising directly or indirectly from the Issuance PLAN CHECK DEPOSIT
a
not be deemed to
aa-
of this permit. Issuance of this permit shall
modify,. waive or reduce any requirement of any city ordinance
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`— —� %y�o1J
nor limit in any way the, City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
1 hereby acknowlstlge} at I have read this application; that the ATTENTION
APPLICATION APPROVAL
it',given (s corfact: nd that I am the owner, or the duly
t 6 ow er. I agree to comply with city and rHls PERMIT
This application Is not a permit until
authorized agen of
stale laws re g I ting o st etlon; and in doing the work authoriz• AUTHORIZES
in violation of the Labor ONLWORK
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
ed thereby, per on it a employed NOTED
Code the t Of W gton re ating to Workmen's Compensa-
acknowledged in space provided.
of INSPECTION
tleR Insuran DEPARTMENT
SIGNATURE NER OR A E T DATE SI NED
CITY
EDMONDS
OFFI AL'S SIGNATURE DATE
—
lA
CALL FOR
RELEASED BY: DATE
ATV INSPECTION
ORIGINAL — File YELLOW — Inspe for
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202
UNTIL BEEN MADE AND APPROVAL OR
q FINAL INSPECTION HAS
A CERTIFickTE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK — Owner GOLD —Ass ssor
CHAPTER 3,
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