930371.pdf®,
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CITY OF EDMONDS ZONE PERMIT
NUMBER 930371
CONSTRUCTION PERMIT APPLICATION JOe SUITE/APTa
OWNER NAME/NAME OF BUSINESS ADDRESS /5�/� //1
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AN LEGAL DESCRIPTION /
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Street Use Permit Req'd ❑
PROPOSED Inspection Required ❑
NAME �d>\• Sidewalk Required ❑ a
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Legal Description of Property - include all easements ALLOWED PROPOSED, COMPLETE EXEMPT
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GRADING CYDS. ; FENCE x^� CHECKED BY TYPESTBUCTION CODE / HEIGHT
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Fee DEMOLISH El.WOODSTOVE SWIM POOL SPECIAL INSPECTOR AREA OCCUPANCYf OCCUPANT
INSERT HOT TUB/SPA REQUIRED GROUP .'+;'� Z LOAD
GARAGE RETAINING WALL/ YES I �--�
CARPORT El ROCKERY RENEWAL EMARKS
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NUMBER NUMBER OF CRITICAL / s`aT��T6s�c�-. •4�/r�h/
o OF DWELLING / AREAS
W STORIES UNITS NUMBER /��I l ,y `j ��t�✓�-L Gs'I�—'DI��A��{
'' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL.INSPECTION REQUIRED
�C�C�A�C �• VALUATION FEE
PLAN CHECK FEE '
BUILDING
HEAT SOURCE: GLAZING t `
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 Appllcalion:180 Days
Permit Limit: I 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
J harmless the City of Edmonds, Washington, Its officials,
5 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 APPLICATION APPROVAL
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 This application is not a permit until
state laws regulating construction; and In doing the work authorize AUTHORIZES
ed thereby, no person will be mployed in violation of the Labor ONLY THE signed by the Building Official or his/her
Cod State of Washin� n relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
ti lnsur ce. INSPECTION acknowledged in space provided.
SIG AT (OWNER OR GENT DATE IGNED DEPARTMENT
CITY OF OFF I L' SI ATURE ATE
EDMONDS �X 0192
CALL A ENTION INSPECTION
LE DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771'�22� ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-87
05
CA
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