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920104.pdfe. . R w is zosr E PERMIT ©� It �11 CITY OF EDMONDS NUMBER E�`/" CONSTRUCTION PERMIT APPLICATION joa , ADDRESS / C OWNER NAME/NAME OF BUSINESS / C..J . I • edait i r:r.Ar_ DESCRIPTION CHECKI SUBDIVISION NO. LID NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. EXISTING REQUIRED DEDICATION PROPOSED TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ a CITY ZIP TELEPHONE NUMBER NAME ENGINEERING MEMO DATED REVIEW BY ADDRESS cc ADDRESS — METER SIZE BUILDING SUPPLY SIZE NO. OF FIXTURES U s CITY ZIP TELEPHONE NUMBER Z O` lO REMARKS U STATE LICENSE NUMBER w SIGN AREA SEPA REVIEW ADB NO. C S Ci ALLOWED PROPOSED COMPLETE EXEMPT Legal Description of Property - include all easements SHORELINE a Z EXP a VARIANCE OR CU PLANNING REVIEW BY DATE U V) O SETBACKS - FEET HEIGHT LOT COVERAGE J FRONT SIDE REAR Tax Account Parcel No. REMARKS I� El NEW � RESIDENTIAL PLUMBING Eli ADDIALTER COMMERCIAL MECHANICAL REPAIR El APT. BLDG. LJ SIGN CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT DEMOLISH GRADING ❑ FENCE C e El CYDS. ( X—FTl O REMODEL GARAGE swim SPECIAL POOL REQUIRED INSPECTOR .7REA OCCUPANCY OCCUPANT GROUP � LOAD ❑ YES ElWOOD STOVE/ RETAINING WALL/ ❑ INSERT ROCKERY RENEWAL REMARKS 0. (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 NUMBER OF STORIES NUMBER OF ' DWELLING UNITS ' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) FINAL INSPECTION REQUIRED VALUATION 4ND 52 GALLON PLAN CHECK FEE (L �� BUILDING J \ c 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 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 ... successors in interest, agrees to indemnify, defend and hold W harmless the City of Edmonds, Washington, its officials, .ji employees, and agents from any and all claims for damages of whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT of this permit. Issuance of this permit shall not be deemed to omodify, 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 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 state laws regulating construction; and in doing the work authoriz• AUTHORIZLY ES ed thereby, no person will be employed in violation of the Labor Code of the State of Washington relating to Workmen's Compensa• WORK NOTED tion Insurance. wsPEcnoN SIGNATURE (OWNER OR ) DATE SIGNED DEPARTMENT CITY D 2 /_ 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. 102•B7 APPLICATION APPROVAL 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. OFFICIA SIGNATUREDATE f - RELEASED BY: DATE R w a L U Z Z Z a ORIGINAL — File YELLOW — Inspector PINK — Owner GOLD — Assessor i Ti iP .