970184.pdfU :mukl w�
0
iw
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
E)XPIR/ATION DATE
If
Pardel No. (/
4/I�✓ vvv vvl
it
w v`
NEW
IPl RESIDENTIAL
IPl
PLUMBINGIMECH
ADDITION
COMMERCIAL
CHANGE OF USE
REMODEL
APT BLDG.
El
SIGN
REPAIR
GRADING
O CYOS
FENCE
f—X_F
DEMOLISH
O WOODSUSOL
INSERTTOVE
El
HOTTPO SPA
CARPORT
ROCKERYG WALL/
❑
RENEWAL
NUMBER NUMIIERYJF CRITICAL
OF 1 DWELLING I AREAS
STORIES UNITS l NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
C
PERMIT 9 7018
NUMBER I
Rl,) 9 /)/-V/x0j/ vie
LEGAL LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING _ REQUIRED DEDICATION
PROPOSED
TESCP A,lydred ❑
RW P.—R.p,,-d ❑
SI-1 Uee Pa ,, R, d ❑
Redulred
Inedeclldn ❑
SldewalX RHIUIred ❑
METER SIZE
LINESIZE
NO OFFI%TURES
PRV REOUIREO
YES ❑ NO ❑
REMARKS
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE JEXE.11
E%P
ADS NO
$HOPELINE %
VARIANCE OR CU
PLANNING REVIEW
BY DATE
SETBACKS — FEET HEIGHT
FRONT SIDE REAR
LOTCOVERAGE
REMARKS
CHECKED BY
TYPE OF CONSTRUCTION COQfi�
C/�I'iL''" 1,6
7
OCCIJgq(gj
Gi�i�\/_9
SPECIAL INSPECTOR
REQUIRED ❑ YES
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC/108
FINAL INSPECTION REQUIRED
-I =
Lhereby.
ion given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
d agent of the owner. I agree to comply with city and THIS PERMIT
s regulating construction; and In doing the work authoriz• AUTHORIZES This application is not a permit until
y, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his/her
he State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
rance and R .27. INSPECTION acknowledged In space provided.
(OWNER O AGEN iI DATE SIGNED DEPARTMENT
NOFFILSOATCITY OFCIT 011SCALL FOR DATE
ATTENTION INSPECTIIOONN�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTI���-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 PINK — Owner GOLD — Assessor
10247
'
PLAN CHECK FEE
' r TV
BUILDING
HEAT SqURCE.
GLAZING
%
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbE, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
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
I 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
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have reatl this application; that the
32
C
19
•
32X I