910763.pdf"�.0 USE
CITY OF EDMONDS ZONE NUMBIER 07
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT0
OWNER NANIE/NAME OF BUSINESS ADDRESS
1 A u `6 LEGAL DESCRIPTION CHECK SUBDIVISIONNO. LID NO. L
ZMAILING ADDRESS
O 1 q;)- i � �- t�"� � �. � � "' 1` PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
CITY ZIP TELEPHONE NUMBER RW Permit Required ❑
EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
�11— 3 S L I PROPOSED Inspection Required ❑
NAME Sidewalk Required ❑ Z
REMARKS
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a CITY ZIP TELEPHONE NUMBER
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NAME
Rn a;,Q A - e I� G��CE
ENGINEERING MEMO DATED REVIEW BY
tc ADDRESS 1V l
U^av4 2 S METER SIZE BUILDING SUPPLY SIZE NO. OF FIXTURES
CITYIx
ZIP TELEPHONE NUMBER W
p II�c.\1V�k S 25�� S(vZZ REMARKS 3
U STATE LICENSE NUMBER
L SIGN AREA SEPA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements I i
SHORELINE N I
Tax Account Parcel No.
NEW 11 RESIDENTIAL
ADDIALTER F COMMERCIAL
REPAIR El APT. BLDG.
El
DEMOLISH
coos.
CARPORT
REMODEL GARAGE
'
I�I WOOD STOVE/ ❑ RETAINING WALL/
I INSERT ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLF
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
(t�S+ aeQ,
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VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
TOR
❑ YES
EXP I
PLANNING REVIEW BY
REAR
DATE
HEIGHT I LOT COVERAGE
INSTRUCTION CODE
= C // I F
GROUP
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
OCCUPANT
LOAD
PLAN CHECK FEE
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
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
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
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 acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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 This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES signed b the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor WORK THE
NOTED Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa• acknowledged in space provided.
tion Insurance. INSPECTION
SI NATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
OFFICI S SIGNATURE 44TE
E
CITY D
EDMONDS
CALL FOR
RELEASED BY:
A ENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771'3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3. PINK —Owner GOLD —Assessor rdl
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