930841.pdfCITY OF EDMONDS ZONE PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION ,Ioa
OWNER NAME NAME OF BUSINESS ADDRESS
y l A D�
/S C- C7 LEGAL DESCRIPTION CHECK SUBDIVISION NO
Z MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
CITY _ Z P TELEPHONE NUMBER
CJ(
NAME
721
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a CITY , / ZIP TELEPHONE NUMBER
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NAME
ADDRESS
411
CITY y j ZIP TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATI N DATE
Legal Description of Property - include all easements
EXISTING REQUIRED DEDICATION
PROPOSED _...
METER SIZE LINE SIZE NO. OF FIXTUF
REM
ENGINEERING MEMO DATED
9 3 p.gd
SUITE: APT a
LID No
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req•d ❑
Inspection Required ❑
Sidewalk Required ❑
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PRV REQUIRED a
YES ❑ NO ❑
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SIGN
AREA
SEPA
REVIEW
ALLOWED
I PROPOSED
I COMPLETE
(EXEMPT
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE
Tax Account REMARKS
Parcel No. �6 Qt- �/ �� (.J ✓` ~ Q
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL 1:1APT. BLDG. El SIGN
GRADING FENCE CHECKED BY TYPE C
® REPAIR CYDS. El ( X_FT)
❑ WOODSTOVE
;
EXP I
PLANNING REVIEW BY
REVIEWED BY
ADB NO,
DATE
HEIGHT I LOT COVERAGE
CODE
DEMOLISH ❑ SWIM POOL SPECIAL INSPECTOR AREA OCdUPANT
INSERT Li HOT TUB/SPA REQUIRED LOAD
GARAGE RETAINING WALL/ YES
CARPORT ROCKERY RENEWAL REMARKS
(TYPE OF USE. BB §INESS O ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305
06
W NUMBER NUMBER OF CRITICAL
o OF DWELLING INUMBER
AREAS , `�/r-1�STORIES UNITS / •' I
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
,/
17 r7 00 r l2e �V 6t e 1 FINAL INSPECTION REQUIRED
�`C✓�Z`� y f ,/ VALUATION FEE
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�^ PLAN CHECK FEE
C?C%�✓C(' ' P LG�� — C Pc'i'i.,i c v (izs Sri'irC ��.
BUILDING
HEAT SOURCE: GLAZING
PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL cJ
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,
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 PLAN CHECK DEPOSIT
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 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
state laws regulating construction; and in doing the work authoriz• AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
�J CITY OF OF A 'S SIG AT RE f DATE
EDMONDS { / c O
ATTENTION CALL FOR ELEASED BY DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� ®ww®
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 11 ORIGINAL — File YELLOW —/essoc
tor
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — A
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RECORD OF
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INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS.:.........
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Footing
Wall....
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Pier/Porch
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Retaining Wall,
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Slab Insulation..