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920033.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS _Mear,r.4 1, t,7"It S r•. NAME ADDRESS �> eLQ(. i-K C- 2 V5I 2-q STATE LICENSE NUMBER S(Am1 S 1+40 (? Legal Description of Property - include TELE TELEPHONE NUMBER E NUMBER �_-43 Z easements USE ZONE PERMIT ►�� NUMBER JOB ADD RESS'437 1' ^' y _EGAL DESCRIPTION CHECK I SUBDIviSI N m salouaz SU IC %� ZIBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. EXISTING REQUIRED DEDICATION OPOSEDMARKS J a c� Tax Account Parcel No, 3qA01 -000,jgod NEW RESIDENTIAL 1:1 PLUMBING ADDIALTER (((❑ COMMERCIAL V3 MECHANICAL REPAIR APT. BLDG. El SIGN DEMOLISH GRADING ❑ FENCE CYDS. ( X_F1) CARPORT SWIM REMODEL El GARAGE POOL WOOD ] NSERTSTOVEI II ROCKERY RETAINING WALL ❑ RENEWAL z (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: EE w NUMBER OF STORIES NUMBER OF o DWELLING 0° UNITS O VDESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) z) 4�,&,r,Ar CeS AI UCSn .I- (J nr3n CZrrl EERING MEMO DATED l J TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ SIZE (BUILDING SUPPLY SIZE I NO. OF REMARKS REVIEW BY SIGN AREA SEPA REVIEW ADB NO. ALLOWED PROPOSED COMPLETE EXEMPT SHORELINE N EXP VARIANCE OR CU ` PL ING REVIEW BY / DATE 4 'f SETBACKS — FEET 17EIGHTrLOTCOVERAGE FRONT SIDE REAR tv. Al uj� BY ITYPE OF SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT REQUIRED ❑ YES GROUP LOAD REMARKS PROGRESS INSPECTIONS PER UBC 305 FINAL INSPECTION REQUIRED VALUATION Q SR PLAN CHECK FEE C�C.-1l `A-" BUILDING P 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 Permit Limit: 1 Year - Provided Work is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE cn successors in interest, agrees to indemnify, defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages ofAl f i whatever nature, arising directly or indirectly from the issuance of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT omodify, waive or reduce any requirement of any city ordinance x nor limit in any way the City s ability to enforce any ordinance provision." TOTAL AMOUNT DUE I hereby acknowledge that I have read this application; that the information given is correct; and that I am the owner, or the duly ATTENTION 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 Insurance. SIGNAT E (OWNERENT) INSPECTION Di SIGNED DEPARTMENT tti , _Q� CITY OF _/ EDMONDS ATTENTION CALL FOR INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC CHAPTER 3. 102.67 c APPLICATION APPROVAI This application is not a permit until signed by the Building Official or his/her Deputy; and fees are paid, and receipt is acknowledged in space provided. ICIAf jS SIGNATURE DATE _Ll D BY: DATE ORIGINAL — File YELLOW — Inspector ,L PINK — Owner GOLD — Assessor �v 111 Z E5 Z W W a 0 Z z Z a 0 Z s J m 1 S pI It NOTICE TO PERMITTEE AND/OR OWNER ❑ PARTIAL APPROVAL y 3 ❑ VIOLATION }I C:. ORRECTIONS REQUIRED ds PERMIT q j NUMBER �' �D� J If JOB ADDRESS © tz J e NO PERMIT —STOP WORK — REMOVE CONSTRUCTION OR OBTAIN ❑ PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS, CONSTRUCTION SIS NOT IN ACCORDA TOP WON MAKE EXIST STING WORK COMPLY WITNCE WITH APPROVED PLANS .-f I ❑ AND PERM APPROVED PLANS AND PERMIT OR REMOVE IT. ❑ STOP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR• a CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN APPROVED. ❑ WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED. CONTACT INSPECTOR AND RECALL FOR INSPECTION. t. ❑ ARRANGE FOR APPOINTMENT. 1 zz I ' If r - S �C-' d Q a�� ' TT �. RECTIONS INDICATED ABOVE ARE REQUIRED WITHIN ' I S i THE ACTIONS OR COR Imo_ DAYS OR PENALTIES IMPOSED BY LAW MAY BE APPLIED. FOR INSPECTIONS CALL: 771-3202. BUILDING DIV. } I❑ PUBLIC WORKS ! I INSPECTOR ' CITY OF � ATE l ❑ FIRE DEPT. I EDMONDS SPECIAL INSPECTION ... It 1 FINAL APPROVAL , i. h `!33 1•