920252.pdfj
46 USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION joe
ADDS
OWNER NAMEINAME OF BUSINESS
EUGENE H. IMAMURA, D.O. LEGAI
� S
PERMIT NUMBER J VG.7�*Q,�Ar'7�r'G2
�'
SUI
16024 - 75th Plc. W.
MAILING ADORES
16024 - 75th P1C. W. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
SW Permit Required ❑
CITY ZIP TELEPHONENUMBER EXISTING REQUIRED DEDICATION Street Use Permit Read ❑
Edmonds 98020 743-6195 SidewInsp.alk
RegUired ❑
_ PROPOSED Sidewelk RegUiretl ❑
NAME REVIEW BY
ENGINEERING MEMO DATED
ADDRESS P,E,IABLE HOLDINGS, INC. Jdba
ARM INSTALLATIONS LTD. METER SIZE BUILDING SUPPLY SIZE NO.Of FIXTURES
CITY ZIP TELEPHONE NUMBER
3810 - 196th WSW n 8 670-1 REMARKS
STATE ER
EXPIRATION DATE
6-1-92
SIGN AREA
SEPAREVIEW
ADB NO,
ARCOI L*141LENSE
ARCOIL*141IE
ALLOWED
PROPOSED
COMPLETE EXEMPT
Legal Description Of Property -include all easements
s oREUNE
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS —FEET
HEIGHT
LOT COVERAGE
FRONT SIDE
REAR
REMARKS
nt 5131-058-004-0005
FXA
PLUMBING
RESIDENTIAL
TION
COMMERCIAL
O MECHANICAL
ElODEL
APT.BLDG.
ElLJ SIGNGRADWG
BY TYPE
Ou F COON RUC�1HEIGHAIR
- CYDs.
FENCECHECKED
(--._FT)
Ej
SPECIALOL INSPECTOR
AREA OCCUPANCY
OPg✓LOAD
Occur
aNOpDTTOVE
DEMOLSH ER
HT
❑ YES
❑ GARAGE ❑ RETAINING WALL!
❑ RENEWAL
REMARKS
CARPORT ROCKERY
PROGRESS INSPECTIONS
PER UBC 305
D (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
y NUMBER OF STORIES
NUMBER OF
Dti�EeDNG
w�
ply _
DESCRIBE WORK TO BE DONE (ATTAUH 1— IL-1
INSTALL GAS WATER HEATER RN MECHANICALFINAL
-
INSPECTION
REQUIRED
rµr� ! i
I
VALUATION FEE
`ROOM , INSTALL. GAS RANNGE & DR=,
PLAN CHECK FEE
P. DXATIONS. 60 FT. FUEL L
RES' LIT
BUILDING
15.00
HEAT SOURCE: GLAZING
a/a
�^�,.,.�V
_5 r W
PLUMBING
Plan Check No.
MECHANICAL
I
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldewPiks,
will require separate permission.
STATE SURCHARGE
i
driveways, marquees, etc.)
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 old
to indemnify, defend and hold
ENG. INSPECTION FEE
k
(I
y successors in interest, agrees
the City of Edmonds, Washington, its officials,
v T--�
PIPING-3 Outlet
3.00
w harmless
employees, and agents from any and all claims for damages of
Indirectly from the issuance
.
whatever nature, arising directly or
of this permit. issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
o 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
the owner. 1 agree to comply with city and
THIS PERMIT
This application is not a permit until
authorized agent of
state laws regulating construction; and in doing the work authoriz•
be in violation of the Labor
LITHOONLY IIZEE
signed by the Building Official or his/her j
Deputy; and fees are paid, and receipt is
ad thereby, no person will employed
Code of the State of Washington relating to Workmen's Compensa•
WORK NOTED
acknowledged in space provided.
1i nlnSUranCe. ER OR DATE SIGNED
E OOWNAGENT DA
INSPECTION
DEPARTMENT
OF CIAL'S GNATURE DAT
I
SIG
/
-13-/
EDMO DS
/
CALL FOR
RELEASED BY: DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
BEEN MADE AND APPROVAL OR
%%1-02`t0
ORIGINAL -File YELLOW -Inspector
/
UNTIL A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK - Owner GOLD - Assessor /•J�
CHAPTER 3.
102 eT