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920391.pdfCITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OW ER NAA1E/NAME OF BUSINESS I f•l Pr)1I NAME ZIP P S tz�✓ = ADDRESS U s CIT ZIP o [e 2 O STATE LICENSE NUMBER <;(ANkt 4S 55N- 133. Leaal Description �of Property - in( USE PERMIT ZONE NUMBER 9aa3� JOB SUITE/APT fl ADDRESS LEGAL DESCRIPTION CHECKI SUBDIVISION NO. ILID NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, TELEPHONE NUMBER EXISTING REQUIRED DEDICATION PROPOSED I NUMBER ELEPHONE NUMBER 622-6?I o EXPIRATION DATE I It) TP all easements Property Tax Account r ©�, Parcel No. NEW ® RESIDENTIAL ADDITION COMMERCIAL REMODEL El APT.BLDG. GRADING REPAIR CYOS. DEMOLISH WOODSTOVE INSERT GARAGE RETAINING WALL/ CARPORT El ROCKERY Z O (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUMBER OF STORIES I NUMBER OF DWELLING UNITS DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) L_1 PLUMBING Lp MECHANICAL LJ SIGN FENCE ( x _FT) SWIM POOL HOT TUB/SPA ElRENEWAL REMARKS ENGINEERING MEMO DATED TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ REVIEW BY METER SIZE (BUILDING SUPPLY SIZE NO. OF FIXTURES REMARKS SIGN AREA SEPA REVIEW ADB NO. ALLOWED I PROPOSED COMPLETE IEXEMPT a EXP VARIANCE OR CU PLANNING REVIEW BY DATE SETBACKS - FEET, HEIGHT LOT COVERAGE FRONT SIDE REAR _ REMARKS BY (TYPE OF SPECIAL INSPECTOR AHtA UlA1UYANGT REQUIRED GROUP//�/� ❑ YES 29� REMARKS PROGRESS INSPECTIONS PER UBC 305 6aS I[FINAL INSPECTION REQUIRED Le 000 iv,c�4�i •PLAN CHECK FEE !9 O D ` t via u� l� BUILDING HEAT SOURCE: GLAZING % PLUMBING Pian Check No. MECHANICAL This Permit covers work to be done on private properly 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 m successors in interest, agrees to indemnify, defend and hold W harmless the City of Edmonds, Washington, its officials, 2 employees, and agents from any and all claims for damages of S whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT 0 of this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirement of any city ordinance °x 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- 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 ATTENTION 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•S7 INSPECTION DEPARTMENT CITY OF EDMONDS CALL FOR INSPECTION 771-0220 OCCUPANT LOAD I�� (D • r�L�L 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. OFFICIALfi SI U E DATE �� RELEASED BY: DATE w a `r? 0 Z 0 ORIGINAL — File YELLOW — Inspector U PINK —Owner GOLD —Assessor I) N„ Y7; III 'k c• IT�yR!'�!' �!^��.lP rvu1Mx'f 47if yA'f"'k.'r � SIR "�`l�.'.� ss ,. � f� .. ` Y^ � `l' l•!'� � _ R'( <5 �. ,'i(.,A, �1� i _r�. }1�'Nt.`.'r �'��t�� y>;� jsi, Y1n,1{''�r7 Q rt r t A