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930254.pdfUSE CITY OF EDMONDS ZONE CONSTRUCTION PERMIT APPLICATION TDB OWNER NAMEiNAME OF BUSINESS ADDRESS LEGAL DE MAILING ADDRESS NAME CIr-,., PERMIT NUMBER SUB PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ZIP TEL PHONE NUMBER �/ EXISTING REQUIRED DEDICATION / a PROPOSED NUMBER ADDRESS CITY ZIP TELEPHONE NUMBER STATE LIC NSE NUMBER EXPIRATION Legal Description of Property - include all easements REMARKS EN DATED 1:1 LI TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ 10 REVIEW BY METER SIZE (BUILDING SUPPLY SIZE NO, OF FIXTURES REMARKS SIGN AREA SEPA REVIEW ADB NO. ALLOWED I PROPOSED COMPLETE IEXEMPT EXP VARIANCE OR CU PLANNING REVIEW BY DATE SETBACKS — FEET HEIGHT LOT COVERAGE FRONT SIDE REAR 0 Tax Account REMARKS Parcel No. NEW © E PLUMBING L _ RESIDENTIAL ADDITION � COMMERCIAL El MECHANICAL REMODEL APT. BLDG. SIGN ❑ ❑GRADING pFN�F x� CHECKED BY JTYPE?F;N��TI CODE HEIGHTREPAIR CYDS. � DEMOLISH WOODSINSERTTOVE El HOT TUB SPA SWIM POOL SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT REQUIRED 11 YES GROUP LOAD CARPORT GARAGE *ROCKERY RETAINING WALL/ ❑ RENEWAL REMARKS (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBCi 305 NUMBER NUMBER OF C ITICAL �(1 OF DWELLING AREAS7`� STORIES UNITS NUMBER /tcii DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) FINAL INSPECTION REQUIRED VALUATION I FEE PLAN CHECK FEE BUILDING 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 Permit Limit: 1 Year - Provided Work is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE (n successors in interest, agrees to indemnify, defend and hold harmless the City of Edmonds, Washington, its officials, m employees, and agents from any and all claims for damages of zwhatever 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 ° 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 information given is correct; and that I am the owner, or the duly ATTENTION 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 rel tang to Workmen's Compensa- WORK NOTED tion Insurance. I INSPECTION SIG T (OW7 OR AG NTI DATE SIG EO DEPARTMENT / US ��' CITY OF t EDMONDS 4a ;; 00L&5e 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. IFI&WS SIGNATJIRE / DAJE 7CALLA TENTION FOR R LEASED BY: DATE INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771=0220 ORIGINAL — File YELLOW — Inspec or A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. PINK — Owner GOLD — Assessor 102d17 A w w Z Z Z W Q w a 0 Z z Z S a. ,,., _..,__. - I LILL __ ILI ..�. , y` t{ r"4 fi� f i All ILL 000 40010 ILI ti Q �y _ .� Is IL y: r� ILL lls' Iz If ILI ILI It ILI - 1 L00 }r \,�. .r 1 A ` Y 4ILI I fIf 1 rf r: f ' , 1 es r t f nII If ,. kL If lq? �r7 ' P6 rt"If, { ,: ILL L s /'It } Av rI I ILItoo, / G► L L PO L IfIfLL If h i i' . {t1,�='"kailt e p7.?JJ J•i t� p r Q , I d -ALL kk OW