960249.pdf200
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I77Ni1 Na•,IE ValtE Ell BUSINESS
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ADDRESS
c,TY
AB DR
FSS o'�
STATE :ICENSE NUMBER EXPIRATION DATE
Leaal Description of Property - include all easements
Tar Account
L 00qEl
ParcelelNo.�(
310, --
NEW
RESIDENTIAL
PLUMBING
AUDITION
COMMERCIAL
MECHANICAL
REMODEL
❑,APT DEC..
I�
LJ SIGN
❑ GRADING CYDS
FENCE
❑
REPAIR
�OEMOLISH
WO
NSEPT TOVE
; KFT
a HOT SWIMPOOL
RETAININGGARAGE WALL/
CARPORT
ROCK E Y
❑ RENEWAL
(TYPE FUSE BUSINESS OR ACTIVITY) EXPLAIN:
�
NULIOER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS /
NUMBER
DESCRIBE WORK TO
BE DONE (ATTACH PLOT PLAN)
4
l
PERMIT
1 NUMBER
/1 SLIITE APT
LEGAL OESCRIP I N CHECK
5U13011ISION NO LID
NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP
RW
Ex15UNG..._.._---- — REQUInEn 0E01CATION _.... ______ 511ePl
PROPOsEo .— Rspeclo,
APPloved ❑
Pe"Requ,Ied ❑
Use PP,mR HP,d ❑
Regmred ❑
MEIER SIZE I
LINE SIZE
NO DF FlxtIIREs
PRV BEO
vEs ❑ NO No 0
REMARKS
ENGINEERING MEMO DATED REVIEWED By
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED I PROPOSED
SEPAFIEVIEW
COMPLETE
E%P
JEXEMPT
A08 NO
SHORELINE r
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS —FEET I
FRONT SIDE REAR
HEIGHT
I LOT COVERAGE
REMARKS
i )
CHECKED BY
TYPE OF CONSTRU ION
LODE
L
OCC PANT
GR P
SPECIAL INSPECTOR
RED
QUIRES
❑ YE
AREA
OCCUPANT
LOAD
EMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
• lAY
I VALUATION
FEE
PLAN CHECK FEE
BUILDING
LJ
I+EaT SOURCEGLAZING
0/0
/ Wl/,
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
END. INSPECTION FEE
Successors in interest, agrees to indemnity, defend and hold
w harmless the City of Edmonds, Washington, its officials,
s employees, antl agents from any and all claims for damages of
a whatever nature. arising directly or indirectly from the issuance
= of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodlty, waive or reduce any requirement of any city ordinance
= nor I, mlt In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
/
prOv's.on."
I hereby acknowledge that I have read this application; that the
APPLICATION
Information given Is correct; and that I am the owner, or the duly
ATTENTION
APPROVAL
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, IT 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 In ,r-.c and CW 18.27,
INSPECTION
acknowledged in space provided.
S,o,,OI'.NE D AGENT, DATE IGNE
DEPARTMENT
CITY OF
OFFICIAL SIGN TU F. DATE
EDMONDS
_ /
CALL FOR
RELEASED BY D TE
ATTEN I N
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 — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER I.
Id] eT
PINK — O•x,ner GOLD — Assessor