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USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION Da
V 'R N AIE NAME CIB )SINE`S
ADDRESS
1� I� U clinr( I C7
NUMBER
S1vA� &A)s7-4UCV ID1)
AnDREss
j / ¢ CITY 21P TELEPHONE NUMBER
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STATE LICENSE NUMBER E%PIRATION DATE
S�v�4-+eE�-KF /7uv G-1-9�
Legal Description of Property - include all easements
Prop"
Tax Account
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Parcel No.
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NEW
ESIDENTIAL1:1
PLUMBINGri
❑ ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
APT BLDG'El
SIGN
GRADING
FENCE
El REPAIR
CVO`
I xF
�OEMOLISH
❑
INSERT TOVE
❑ HOT TUBSPA
❑
RETAINING WALL/
❑GARAGE
CARPORT
ROCKERY
RENEWAL
11 NUMBER NUMBER OF CRITICAL
G OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK' I Gi'✓1RLF't Li
PERMIT
NUMBER
If SUIIE APT.
LEGAL DESCRIPTION CHECI
SUBDIVISION NO
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING__—____ REQUIRED DEDICA11ON____.._.
PROPOSED _�
TESCP Apprpedd ❑
RV/'. —I Requ,red ❑
S-et w. P,,-Regd ❑
Inxp.l—Renu,red ❑
METER SIZE I
LINE SIZE
I NO OF FI%TURES
PRV REQUIRED
YES ❑ NO ❑
IIEM
74/,4/ kaL. c7A//k D iJt��
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ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
BEPA REVIEW
LETE EW
COMPI IEMPT
EXP
AGE NO
SHORELINE x
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
FRONT SIDE REAR
I HEIGHT
LOT COVERAGE
HEMARK5
r' Air f iiryj Ifo d'i Jj
F CQNSTPIICjION COq��
V
4
GC nNT
7REMARKS/
AREA
OCCUPANT
LOAD
ECTION ER UBC 108
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
HEAT SOURCE
GLAZING
%
PLUMBING
11
Plan Check NO.
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
—
Permlt 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
Successors in interest, agrees to indemnify defend and hold
W harmless the City of Edmonds, Washington, its officials,
i employees, and agents from any and all claims for damages of
a Whatever nature, arising directly or indirectly from the issuance
x of this permit. Issuance of his permit shall nol be deemed to
PLAN CHECK DEPOSIT
9 modify, waive or reduce any requirement of any city ordinance
N
nor Iimit 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
APPLICATION APPROVAL
information given is correct: and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
Th application is not a permit until
state laws regulating construction; and In doing the work aulhoriz•
Labor
AUTHORIzEs
ONTHE
ne by the Building Official or his/her
9 9
ad thereby o person will be employed in violation of the
to Workmen's Compensa•
WORK NOTED
epu ; and fees are paid, and receipt is
Code of the tale of Washington ;ela g
lodged in space
tion Insura a and RCW 18.27.
INSPECTION
ackn Irovr .
SIGNATURE I NI R OP AGENTI DATE SIGNED
DEPARTMENT
CITY OF
FI IG A UR .E
C�i r 1
EDMONDS
G
CALL FOR
E1E45 D DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL H FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� �OGLO
ORIGINAL — Flle YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
///
SECTION 109
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PINK — Owner GOLD — Assessor
IOT 87
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