950211.pdfCITY OF EDMONDSUSE
CONSTRUCTION PERMIT APPLICATION
ZONE PERMIT
.S'- /.� NUMBER ✓Sa�,.� .C.
OWNER /NAh7E-NAME OF BUSINESS
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J08 //.. 1 SUITE/AP
ADDRESS � � / _ 1
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LEGAL DESCRIIPTTION (CH/ECK
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MAILING ADDRESS
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SUBDIVISON NO UUDD�
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l.11y ZIP
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TELEPHONE NUMBER
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP
EXISTING.._— REQUIRED DEDICATION RW
Street
PROPOSED I-Peclmn
Side-11,
Approved ❑
Permit ROWIred ❑
Uae Permit Feet d ❑
Required ❑
Required ❑
NAME
L'N A I I A C Q l Ct I rVr
METER S1ZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑
ADDRESS
RE!WKS
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CITY ZIP
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TELEPHONE NUMBER
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NAME��{
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ADDRESS �I
ENGINEERING MEMO DATED REVIEWEDBY
CITY ZIP
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TELEPHONE NUMBER
(G I IEXPIRATIOiN
FIRE MEMO GATED REVIEWEODY
STATE LICENSE NUMBER DATE
C-�-
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
EXP
ADO NO.
Legal �DLescription of Property - include all easements
•3 T40 -G(JL Ci(3-00 4,
SHORELINE
5k'lQr -GC)1 CI ()t -nl C,r
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS -FEET
FRONT SIDE REAR
HEIGHT
LOT COVERAGE
Property y 3 4 t:, - �u-2 �p f 3 —ao0
Tax Account
Parcel N. ,SLR( •• OC)2 &0L-0IOC"
REMARKS
ElNEW LAY, RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
ElREMODEL APT, BLDG. SIGN
CYDS
REPAIR ❑ GRADING FENCE K—�
WOODSTOVE
DEMOLISH ❑ SWIM
INSERT ❑ HOT TUBPOOL/SPA
GARAGE ❑ RETAINING WALL/
CARPORT ROCKERY � RENEWAL
CHECKED BY
TYPE O„ CONSTRUCTION
.01 CO NST111
CODE
/1%y
CCUPAN
SPECIAL INSPECTOR
REQUIRED
YES
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYPEp;fB,Quslnr7S !SORACTIVITY)EXPLAIN:
NUMBEROF
STORIES /
DESCRIBE WORK TO BE DONE
I NUMBER OF n/
UNITS LNG ONe,
IATTACH PLOT P11ANI
CRITICAL/(p/-7y
AREAS
NUMBER /-� /
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
CLLA_II_Nr_G
BUILDING
`-
IN,
J
PLUMBING
Play Check NO.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldewPlks,
driveways, marquees, etc.) will require separate permission.
Permit Application:180 Days
STATE SURCHARGE
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
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successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
aemployees,
and agents from any and all claims for damages of
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whatever nature, arising directly or Indirectly from the Issuance
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of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
PLAN CHECK DEPOSIT
x
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I��IU
I hereby acknowledge that 1 have read this application; that the
information given Is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz•
THIS PERMIT
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 AGENTI nATE SIGNED
DEPARTMENT
1 . < Y�..n l� ���
P i � L
CITY OF
OF I IA 'S sl ATURE DATE —
EDMONDS
- - J
ATTENTION
CALL FOR
INSPECTION
ILEA 13. DATE
��
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
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ORIGINAL - File YELLOW -Inspector
CHAPTER 9.
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PINK - Owrer GOLD - Assessor
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