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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION aoa
OWNEn NANIL NANIF. OF BUSINESS i� ADDRESS R yO L 1 IA /
t. _ fL.L-�'�— F/ LEGAL DE5CRIPTIONN CHECK SUBDIVISIVON NO ��"�
M AILINti annnESS
I S F "nl 'Li r N��.
�� � �'�L'[/ Vie, I
PUBLIC RIGHT OF WAY PEP OFFICIAL STREET MAP
TESCP Approved ❑
CIIt /
,:II`
TELE PHONE NUM BE
EK1511N6 REQUIRED DEDICATION --_
RWe Repuned ❑
Slrael el UsUae Pe,—Rnq'd ❑
p
i�
'7
-Paclwn Ragelmd ❑
PROPOSED
Sidewalk Peru.— D
NAME
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I
I
I YES D NO ❑
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NAME A ' .� } .'J A I /I fi. . �•.
¢o ADD S;� 41 /l./ ENGINEERING MEMO GATED
nGT O i] TELEPHONE NUM"t
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�7 FIRE MEMO pATEp
O V
O STATE LICENSE NUMBER E PWATt IN PATE
^ 4n�F l o� DSS (J SIGN AREA SEP/
rY ALLOWED I PROPOBEO I COMPLETE
Legal Description of Property - include all c9senyg0t�
UU ExP
SETBACKS — FEET
FRONT SIDE
Property
Tax Account
/527
Parcel No.
D.�--O/6^r/
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REMARKS
NEW
El ADDITIONCIAL
REMODELG.
REPAIR
❑
TIAL
LF
GRADING
CVGS
WOODSTOVE
PLUMBIN"ECH
COMPLIANCE OR
CHANGE OF USEEl
El SIGN
FENCE
(_x_FT)
❑ SWIM POOL
CHECKED BY TV
SPECIAL INSPECTOR
ADB NO
IEW BY DATE
HEIGHT LOT COVERAGE
DEMOLISH ❑ INSERT H�OTTUWSPA REQUIRED
•�y ❑YES
❑GARAGE RETAINING WALL/ Fl
CARPORT ROCKERY EMARKS
___ .... PROGRESS INSPECTIONS PER UBC 108
1001
OF DWELLING
IDWELLINGNU NUMBER F IAREAS AM
OCCUPANT
LOAD
-'
DES EWORK TO eEO ry InI1nUnY vr�nnl
_� / �✓ �- Z 5�
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING
BUILDING
PLUMBING
Plan Check No.
Check
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRAOINGIFILL
Any construction on the public domain (curbs, sidewPlks,
Driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Gaya
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Wilhin 180 Days
"Applicant. on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
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City of Edmonds, Washington, its officials,
harmless the
and agents from any and all claims for damages of
s'
T
employees,
whatever nature. arising directly oer Indirectly from the issuance
of this shall not be deemed to
PLAN CHECK DEPOSIT
omodify,
of this permit. Issuance permit
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
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 thesowner, or the duly
aulhorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz
UTHORIzONLY +Es
signed by the Building Official or his/her
a,, thereby, n0 person will be employed In violation of the Labor
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa
acknowledged In space provided.
lion Insurance and RCW 18.27.
INSPECTION
SIGNATURE ,77O��W//N/EE'R' OR AGENI) DATE SIGNED
OEPARTMENi
i[./F'y�'( r •L,��
TY OF
EDIMO DS
MATURE
�.AJ�TE
6 /
CALL FOR
LEASE GATE
AT T E N TI O N
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
1 ORIGINAL — Foe YELLOW —Inspector
��� �OLGO
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK — Owner GOLD — Assessor
SECTION 109
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TO: Permit Coordinator, Building Division
FROM:F1R DEPARTMENT,
:', E
ENGI
NEERING'
PLANNING DIVISION,
OWNER
PERMIT# INSPECTED
L L ON 497':'
A field inspection wass-conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the Lgranting -of:
Occupancy for the ,bui I dilng Performance Bonds may be released
Maintenan I ce Bonds ,may Lbe released Landscaping,is approved
;h, Other inspected.- e
PASSED FIRST INSPECTION CONDITIONS NOTED
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FAILED INSPECTION OUTSTANDING REQUIREMENTS RECALL. FOR INSPECTION,�
1.
2.
kt
3.
4.
OCCUPANCY 4
:APPROVAL � AT
7 ik
4.
'FAILED FIRST :INSPECTION -DATE 65
RE -INSPECTED APPROVED DATE BY
RE -INSPECTED 'FAILED -DATE
RE -INSPECTED APPROVED`DATE`.
FEES E C E I PT #
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RECORD OF INSPECTIONS
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