970249.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE11N411E NAMEOFBUSINESS
0?e y er
MAILING ADD E55
I / , , -T c , ) - lh �/
ADDRESS
1nOPE55 �1
�(IITY 1 ZIP
STATE LICENSE NUMBER
Leoal Description of Property -
n
PERMIT 9
NUMBER
RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved ❑
PUBLIC
RW Permll Reduced ❑
EXISTING REQUIRED DEDICATION
Sheet Ufa IF,— Rep a ❑
I
Impecnen Radmred ❑
PROPOSED
Sidewalk Required ❑
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
I
I
I YES ❑ NO ❑
SIGN AREA SEPA REVIEW ADB NO
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE%
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
O
SETBACKS — FEET HEIGHT I LOT COVERAGE ?
FRONT SIDE REAR _ q
P,.Tax Account vJt �U( /, REMARKS
Percel No. v
NEW RESIDENTIAL O PLUMBINGRRECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
ElREMODEL APT BLDG. El SIGN
CHECKED TY
GRADING FENCE BY
GPE ONS gJCTION C /
REPAIR CYDS. 1_K_Fm l//
ElDEMOLISH ❑ WSEORTTOVE r7 HWIMPOOLA SPE REQDIALUIRED SPE;TOR AREA
cif, ✓Y ❑YES
GARAGE 177 RETAINING WALL/-wl•[RJB`rWd' R MARKB
CARPORT ROCKERY L
PROGRESS INSPECTIONS PER UBC 108
(TYPE OF USE,BUSINESS OR ACTIVITY) EXPLAIN:
0 0/7 /
NUMBER NUMBER OF RITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) -
ec(/
FINAL INSPECTION REQUIRED
77 t; J
c kFLX c i.x El PCC L Tr
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE'.
GLAZING
D/D
PLUMBING
Plan Check No
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRAOINGtFILL
Any construction on the public domain (curbs, sldewPlks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
•Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnity, delentl and hold
w
harmless line City of Edmonds, Washington, its officials,
employees, and agents Irom any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
Issuance of this shall not be deemed to
PLAN CHECK DEPOSIT
os
of this permit. permit
modify. waive or reduce any requirement of any city ordinance
11
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
/!�Ip•)v
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This plication Is not a permit until
State laws regulating construction; and In doing the work aulhoriz
AUTHOPIZEs
si the BuildingOfficial or his/her
no
ed thereby no person will 6e employed in violation of the Labor
WORK NOTED
Dep t ; and fees a e paid, and receipt is
Code of i e Slate of Washington relating to Workmen's Compensa•
ac ledged in ece provided.
tion Ins ante and RCW 18.27,
INSPECTION
SIGNATUy 101 NER�,TI .ATE SIGNED
J
DEPARTMENT
CITY OF
OF IGNATURE E
t �T %
EDMONDS
CALL FOR
R LEASED 6Y DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� -OwLLA®
ORIGINAL — File YELLOW —Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
IpaeT
PINK — Owner GOLD — Assessor
--0-------
• ;...
32 Xft
N
I `W&1�11
C9
M
TO
ALE
TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT. DATE 2L4A7
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE
OWNER ADDRESS LJ
PERMIT# 5-Z')ZYJ'—ADB# -INSPECTED ON.
A field inspection was conducted to determine compliance with approved plans. Final approval
denotes there are no objections to the granting of
—Occupancy for'the building _Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
-Jr—Other inmected.
--.ZLPASSED FIRST INSPECTION - CONDITIONS NOTED
I. S�No /q, ti(&4/W4--'0
-----YAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR
INSPECTION
2.
3.
r
1 0 0
I -
32X L
a