920257.pdf0
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orEiE �C _ �� PERMIT dZ17
CITY OF EDMONDS i NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT4
OWNER NAME/NAME OF B SINESS ADDRESS l
KeI'1 PoAe h LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
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� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. Approved ❑
CITY�Fp V ZIP TELEPHONE NUMBER RW Permit Required ❑
`_ EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
���� 9�02 '79 y- OJ � Inspection Required ❑
NAME PROPOSED Sidewalk Required ❑ 0
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REMARKS ¢
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NAME Q
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C / GJFC I Z / / 7 � SIGN AREA SEPA REVIEW B N0.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
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° VARIANCE O CU PLANNING REVIEW BY DATE
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SETBACKS —FEET f J HEIGHT LOT COVERAGE Z
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Tax Account REMARKS a
Parcel No. lrQ v\ce`
NEW El RESIDENTIAL El PLUMBING N
ADDITION 1:1COMMERCIAL
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REMODEL Ej APT. BLDG. SIGN
❑❑ GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
REPAIR CYDS. (x_FT)
DEMOLISH WOODSTOVE SWIM POOL SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
INSERT El HOT TUB/SPA REQUIRED GROUP LOAD
GARAGE RETAINING WALL/ YES
CARPORT El ROCKERY RENEWAL REMARKS c7
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 Z
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DESCRIBE ORK T BE DONE (AT;ACH PLOT PLAN)
FINAL INSPECTION REQUIRED
` J VALUATION 7FEEEPLAN CHECK FEE
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HEAT SOURCE: GLAZING
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
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harmless the City of Edmonds, Washington, its officials,
¢ employees, and agents from any and all claims for damages of
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
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. 1 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
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ti n Insurance. INSPECTION acknowledged in space provided.
SIGNATURE I WNER OR ENT) DATE SIGNED DEPARTMENT
CITY OF OZ%60-ki
L'S SIGNATURE DATE
EDMONDS / t %Z
CALL FOR RELEASED BY: DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 7714220 ORIGINAL — File YELLOW — Inspector
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A GtM I IhIGA I t OF uGGuYAIVIoT nM0 DGGIv
CHAPTER 3.
102.87
PINK — Owner GOLD — Assessor e
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