930692.pdfUSE
CITY OF EDMONDS tE
PERMIT
CONSTRUCTION PERMIT APPLICATIONNUMBER f✓
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OWNER NA ME NAME/OF BUSINESS ' / � 3�2C� `I �C� 1`--`/ f4 to e&5e A CRIPTION✓CHECK .SUBDIVISION NO
MAILING ADDRESS%A 3,�6 w.S� PZ4J HT OF WAY PER OFFICIAL STREET MAP.
CITY ZIP TELEPHONE NUMBER-`�5�REQUIRED DEDICATION
sNAME IZE LINE SIZE NO. OF FIXTURES
ADDRESS
REMARKS
CITY ZIP TELEPHONE NUMBER
NAME
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HONE NUMBER
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STATE LICENSE NUMBER EXPIRATION DA
MF�TAL.z%�4 41 c -9-- qL
Legal Description of Property - include all easements
Property
Tax Account
Parcel No. 177�
NEW L:J RESIDENTIAL F PLUMBING
ADDITION COMMERCIAL MECHANICAL
LJ REMODEL APT. BLDG. El SIGN
❑ GRADING El
REPAIR CYDS. ( X _FT)
DEMOLISH ❑ WOODSINSERT TOVE El HO M POOL A
GARAGE RETAINING WALL/ I�l
CARPORT ROCKERY I I RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
w NUMBER I NUMBER OF CRITICAL
❑ OF DWELLING AREAS
CO STORIES UNITS NUMBER
' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
ENGINEERING MEMO DATED
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
BY ITYPE
W SUITE -APT d
TESCP Approved ❑
RW Permit Required O
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
PRV REQUIRED
YES ❑ NO ❑ 3
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REVIEWED BY
SEPA REVIEW I ADB NO.
COMPLETE IEXEMPT
SHORELINE
EXP
PLANNING REVIEW BY DATE
REAR
HEIGHT I LOT COVERAGE
0
SPECIAL INSPECTOR ( LOAD
OCCUPANT
❑
REQUIRED YES
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
LU/� TFe 14x;rce � r,��-wf VALUATION
07EPLAN CHECK FEE
77
BUILDING
HEAT. GLAZING
PLUMBING
Plan Check No.
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
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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
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
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modify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City s ability to enforce any ordinance
provision.'
I hereby acknowledge that I have read this application; that the
MECHANICAL
GRADING/FILL
STATE SURCHARGE
STORM DRAINAGE FEE
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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 be employed in violatioL
Labor ONLY THE
Code of the State ashin ton relating to Workmepensa woRK NOTED
suranc nd RCW 1 .27. INSPECTION
/ DEPARTMENT
`� CITY OF
EDMONDS
ATTEN ON CALL FOR
INSPECTION
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.
OFFAAAL'S-SVhPATURE DATE
RELEASED BY
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DATE
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IT IS U, WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE I
UNTIj A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 0220 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
I:
CHAPTER 3. PINK — Owner GOLD — Assessor
102.87
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