960727.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
11111E li NAhIL NAME OFF US IN E SS
sky 6i AJ
W MA NG ADORE SS
,'Ur SIP iELEPH ONENUMBER
I- k 1-a.
ME
all easements
DATE
Tax Account Sl 3 s-_ �b -//0 0 _ Parcel No.
ElNEW RESIDENTIAL PLUMOING'MECH
COMPLIANCE OR
ADDITION El COMMERCIAL CHANGE OF USE
REMODEL All BLOG. SIGN
REPAIR O GRADING Cv05 ❑ PENCE Y—F
�O[AtUL15H ❑ INSHOT
SWIM POOL
❑ HOT TUBISPA
GARAGE r-1 CARPORT ROCKERY IG WALL/ ❑ RENEWAL
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMB[R
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
9
mNE PERMIT
NUMBER
ADDRESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO LSO
NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApp—ed
RW
EXISTING.._.____ REQUIRED DEDICATION .._.____ S,
PflonoscD __ mrPeceon
"— -- -- - SId-11
❑
Perm,l FINI" .rf ❑
Una p,,rm,l R, ❑
Roauved ❑
Penuvml ❑
METIT1111E
LINE SIZE
NO OIFIXTURE$
PI1V 11EOUNEO
YES ❑ NO ❑
RCMARKS
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED) UY
SIGN AREA
ALLOWED PROPOSED
SEPAREVIEW
COMPLETE JEXEMPT
EkP
ADO NO
SHORELINE A
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
FRONT SIDE REAR
HEIGHT
I LOT COVERAGE
REMARKS
CHECKED BY
TYPE OF CONSTRUCTION
/_/RU
COD4
//11
ORCU
SPECIAL INSPECTOR AREA
REQUIRED
YEB
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 108
FINAL INSPECTION REOUIRED
ul S i L u b
"
PLAN CHECK FEE
Z. //`
IV
BUILDING
% %7
HEAT SOTUR. E
d� C
GLAZING
p/d
PLUMBING 8
V
G..ar
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
ENG. INSPECTION FEE
v successors in interest, agrees to indemnify, defend and hold
'—
w harmless the City of Edmonds, Washington, its officials,
12&1
a employees, and agents from any and all claims for damages of
whatever nature. arising directly or indirectly from the issuance
T of Ihis permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodify. 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
DID Slon."
I hereby acknowledge that I 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
THIS PERMIT
This application is not a permit until
stale laws regulating construction; and In doing the work authoriz•
ed thereby, no peFGon will be employed in violation of the Labor
AUTHORIZES
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 antl RCW "127,
INSPEcHO.N'
acknowledged in space provided.
51GNA U �Ow NEP GENII GATE S NED
OE PARTMENT
.�-
D
CITY OF
EDMONDS
0 IAL SIGNATURE TE
iiir
CALL FOR
FLEA pY DAtE
ATTE 104 61
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
SECTION 109
1112 aT
PINK — Owner GOLD — Assessor
✓"� A , i � i....