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USE PERMIT •!��"7,
CITY OF EDMONDS ZONE NUMBER
178
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT4
ADDRESS f rL1 c V ( aW r
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OWNER NAME/NAME OF BUSINE S G (/ ��l
A)
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
MAILING ADDRESS V ��]�
�lj v((j(/t</ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. RW Pe Approved ❑
ZIP TELEPHONE NUMBER RW Permit Required ❑
PNAM
EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
Inspection Required ❑
/✓ PROPOSED Sidewalk Required ❑ t
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REMARKS L
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ADDRESS
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CITY
ZIP TELEPHONE NUMBER
NAME
ADDRESS
11
706 5C
LICENSE NUMBER
Property
Tax Account %
Parcel No. /
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
❑GARAGE
CARPORT
rTYPE OF USE, BU:
of Property - i
EXPIRATION DATE
000
e alleasements
ENGINEERING MEMO DATED
SIZE
SUPPL'
REVIEW BY
NO. OF FIXTURES
SIGN AREA SEPA REVIEW
ALLOWED %I PROPOSED COMPLETE IEXE
NO.
EXP
VARIANCE OR CU ' PLANNING REVIEW BY DATE
SETBACKS - FEET ` HEIGHT LOT COVERAGE
a FRONT SIDE REAR
/ o43 ~ � 6 8+ 00 � 0 REMARKS
%
0 RESIDENTIAL El PLUMBING
COMMERCIAL L� jjj MECHANICAL
APT. BLDG. El SIGN
GRADING ❑ FENCE
CYDS. ( x--FT)
WOODSTOVE SWIM POOL
INSERT I HOT TUB/SPA
I I RETAINING WALL/ on0 RENEWAL
' I ru CAY
>INESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES I NUMBER OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FPROGRESS
INSPECTOROCCUPANCY OCCUPANT
ED GROUP LOAD
❑ YESS
INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
F
/ G 11 .. - a. - - - —
`glvfC* r� �G4.e-600w�PLAN CHECK FEE
1 4 ''V L J/ I BUILDING
URCE: 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
u, successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
iwhatever nature, arising directly or in, 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- LITHOONLY TIZE
HE
ed thereby, no person will be employed in violation of the Labor WORK 140TED
Code of the State of Washington relating to Workmen's Compensa- INSPECTION
tl n Ir1SUranCe. DATE SIGNED DEPARTMENT
SIGNATUR H
L
NTI
�9 CITY
OF
(p EDMONDS
--Mai
CALL FOR
AT -ENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771=0220
UNTIL CERTIFICATE INSPECTION
E OCCUPANCY HAS EN ADE N BEENGRANTED,
D APPROVAL OR
AUBC
CHAPTER 3.
102.87
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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.
OFFICIAVV SIgNATgE DATE
BY:
DATE
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ORIGINAL — File YELLOW — Inspector L
PINK — Owner GOLD — Assess
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