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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OIVNER yAME N ME DF BUSINESS
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NAMEI
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STATgJ.1JNSE H
r legal ascription of Property - mclude all easements I r
Parcaf No. 121 ► - a - 11 -ac�I �/aI
NEW RESIDENTIAL ILUMBING/MECH
COMPLIANCE OR
ADDITION El COMMERCIAL CHANGE OF UsE
ElREMODEL APT. BLDG. SIGN
REPAIR ® RADINL 'L is I ENCE x_
IN DEMOLISH ❑ NSERT TOVE NOIM POOL
T TUO SPA
ZIGARAGE
CARPORT ROCKERYG WALL/ ❑ RENEWAL
u (TYPE OF US r{F¢S OR ACTIVITY) EXPLAIN.
y NUMBERIS
{!` NUMBER OF CRITICAL %
0 STORIE17-1 - "+- UNITS WELLING v�r NUM IS
ER `•���
DESGCj TO BED E T CH PLOT PLAN)
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PERMIT
1`•S /2 IZNUMBER 980460
PUBLIC RIGHT OF WAY
PER OFFICIAL STREET MAP
TESCP Approved
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RW Permll Repaired
a
EXISTING _ _�'
PROPOSED
nEOUIRED DEDICATION _.L.=_-_
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Sl, ,Uxe P.—, Repd
Infp.-RWPl
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/
S-w-Rapu—
METE SIZE
L/E,�IZE
NO OFFI�RFS
3
PRV REQUIRED
vEB�NO❑
3
flEMARKS II15
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SI+4
16
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V-44'
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..MLM.�NnI EU REVIEWEDBY
VARIANCE 09 CU
AOB M
SHORELINE M
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n1A
48
SERA REVIEW
COMPLETE I EXEMPT
E�s
SIGN AREA
ALLOWED I PROPOSED
—
HEIGHT
ALLOWED PROPOSED
3a'rK ZeiZ'
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT VR SIDE REAR
3507 1 J2
1 7-5, fa' 45'
32,'
LOT AREA
2- f e
PLANNING REVIEW SY
�r a+v
DATE
)
REMARK
fZet,N Yrvx
6e
,�TEifns7v.�1 a� f'xl,1d �ELYSoo oslcd—� g'
C�E KEE.p�BY TYPE OF C, STRUCTION
O lLf�
COD
OCCUP T
GRD
`—mil �AYr
SPECIAL INSPECTOR
AR � Z L
OCCUPANT
REQUIRED Iy YES
T
LOAD
REMARKS
PER
PROGRESS INSPECTIONS UBC 108
Eht269d•f5
50/a kP LIYAAxK K. oa LqdS42--s-0b
FINAL INSPECTION REQUIRED
o
VALUATION
FEE
Nrlfi1 ye) 660 �'/
PLAN CHECK FEE
MEAT SOU�7CE/�
GLAZING
BUILDING
�� ��
2 0& Z
PLUMBING
%
Plan Check No.
MECHANICAL
✓ C
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
I Ste(
Any construction on the public domain (curbs, sldewPlks,
VVV(((
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
30
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
3 O
,A successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its o"'CiB'S,
o is10! ,4l `C
,. JI-
(v/k-, &5
pv
s employees, and agents from any and all claims for damages of
a whatever nature, arising directly or indirectly from the issuance
,,
.
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodify, waive or reduce any requirement of any city ordinance
z 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
information given is Correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. 1 agree to comply With city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
This application is not a permit until
Ed thereby, no person will be employed in violation of the Labor
0NU THE
signed by the Building Official or his/her
Code of a
tale of Was in Ion relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
do In r n
k aria R 8. 7.
R AG
INSPEcr1oN
acknowledged in space provided.
SIGN TU E 1
f I
/
N
DATE BIGNED
DESPECTI NL
CITY OF
EDMONDS
d FICIAL551 NATURE GATE
{ ��
ATTENTION
CALL FOR
INSPECTION
Lq D'
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 GRANTER UBC
'4t£.
SECTION 109
IPaeT
PINK — Owaer GOLD — Assessor
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