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PERMIT EXPIRES
PERMIT
90038
CITY OF EDMONDS
20NE �S .- r 7_ NUMBER
CONSTRUCTION PERMIT APPLICATION
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LJC CARPORT
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
PROGRESS INSPECTIONS PER UBC 100
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NUMBER
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NUMBER OF.
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DESCRIBE WORK TO BE DONE
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VALUATION FEE
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BUILDING
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PLAN CHECK N �s
VESTEp DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO,
f BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
- DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MAROUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 1B0 DAYS
PERMIT LIMIT: 1 YEAfl • PROVIDED WORK IS STARTED WITHIN 180 GAYS
STORM DRAINAGE FEES
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•APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG, INSPECTION FEE
-
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY. OF
FROM ANY AND
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EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. ANDAGENTS
FOR DAMAGES OF WHATEVER NATURE, ARISING DIRF.CTLYORINDIRECTLY
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pLLCLAIMS
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
pLpN CIIECK DEPOSIT
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0 DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAYTHE CITV'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
_
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
WITHCITY AND STATE LAWS REGULATING CONSTRUC-
CALL
ThIs aPPIllahon is not .- P.—I unlit s,gnpe by lho
THE OWNER. I AGREE TO COMPLY
TION; AND DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION
Brn1Cin9 OII're1al aria ha, Uopuly'. and Fops aA Pd. and
is ncknowlahgod In 5pacp pr .dld.
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IN VIOLA GN OF THE LA00R CODE OF THE STATE OF WASHMGTON
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WORKM''SCOMPENSATIONI RANCE AND RCW 18.27.
DATE SIGNED
(425)
OFFI I NATOATS—
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SIG A RE (OWNER OR AG
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771 -0220
RE Fn5 .�7� fj�1'
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ENTION
T IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
LE YELLOWCTOR
ORIGINAL - FILE INSPE
ORNSPEGR I
L FILER
OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 100
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STATEMENT ON ACCESSORY DWELLING UNITS
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Property Address: _
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Edmonds, Washington
Legal Description:
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Assessor's Parcel Number:'
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
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the Edmonds Community Development Code and understand that an accessory dwelling
unit, including a second kitchen, is prohibited for two years after occupancy by the
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current owner (unless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
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Examiner.
I also understand that approval of a conditional use permit is subject to a public
to
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hearing, and neither this statement nor the issuance of a building permit shall act
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limit the discretion of the City in the review of any, application for a conditional use
permit:
Property Owner Signature: /aQ�Rt% l CLQ rn
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Date: Z-2/r
STATE OF WASHINGTON)
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COUNTY OF SNOHOMISH)
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J I certify that I know or have satisfactory evidence that �� Ls�✓N, +e�r"
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signed this instrument and acknowledge it to be hi�t'ree and voluntary act for the uses and
purposes mentioned in this instrument.
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Notary'spressure seals must be smudged. Dated:
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Signature of
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Notary Public:
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Residing at:
My Appointment
j Expires:
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THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
Sl ... SETBACKS ..................... v:
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( FOUNDATION:
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Footing ••••
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PledPorch .................
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OCCUPANCY - - ... _//J��'.
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PERMIT EXPIRES
CITY OF EDMONDS
ZGNE
NUMBER
313038
CONSTRUCTION PERMIT APPLICATION
JOBREss
SUITEIAPT-
OWNER NAMEINAME OF BUSINESS
LEGAL ESCRIPTION CHECK
B01 ISION NO.
LID NO.
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PUBLIC RI..TOFWAVPEROFl
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TELEPHONE -
qW Paemll Boyuimtl
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❑❑
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IT ZIP
EXISTING
REQUIRED
DEDICATION_—
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PROPOSED
Ewa
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES ❑ NO
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REMARKS
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TELEPHONE
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY rw
ZIP EPHONE
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ADBn
SHORELINE
EXPIRATION DATE
'•
CHE KED BY
FEXP
SIGN AREA
ALLOWED PROP
HEIGHTPT
ALLOWED P BEDE
INCLUQE ALLE EME TS
pgOPOSED
REQUIREDSETBACKS(FTIPROPOSEDSETBACK$(FT)
FRONT SIDE REAR
FRONT URSIDEREAR
ICE N0.
LOT AREA
PLANNING REVIEW BY
- DATE
I 21
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RESIDENTIAL
PLUMBING I MECH
AEMARKS
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4❑i^ ADDITION
❑ COMMERCIAL
❑ COMPLIANCE OR
CHANGE OF USE
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❑' REMODEL
❑ APARTMENT
❑ SIGN
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REPAIR ❑ GRADING -CYDS " ❑ FENCE .%- F.T)'
_OHECKEDBY
TYPEOFCONSTRUCTION
COOS OCCUPANT
GROUP
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YYYC
❑ DEMOLISH ❑ TANN ❑'OTHER
OCCUPANT
m m
❑ RETAINING WALL ❑ RENEWAL
SPECIAL INSPECTOR
REQUIRED❑ YES
L LOAD
(-
065
CARPORT FOCKE
F (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
O
-
PROGRESS INSPECTIONS PER UBC 108
_
N
w NUMBER NUMBER OF
CRITICAL Iq 1 ✓f 7L
m n
I
m OF / DWELLING
AREAS
Z
o STORIES UNITS
NUMBER
DDD
DESCRIBE ORK TO BE DONE
REQUIRED
z
FINAL INSPECTION
VALUATION
FEE
_
PLAN CHECK FEE
Z
O
A R E AZ G °i
LOT SLOPE I
BUILDING
n
P CK NO:
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THISP MI 0
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC O C
R DI GIFILL
— DOMAIN (CURBS,SIDEWALKS, DRIVE WAVS,MAROUEES, -
J SEPARATE PERM ISSION.
STATE SURCHARGE
uPI PERMIT APPLICATIO: 1B0 GAYS
-
PERMIT LIMIT: 1 YEAR -PROVIDED WORKNIS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
I�
'APPLICANT. ON BEHALF OF AIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF',
a."INTEREST,
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMSFORDAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
p DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITV'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION:
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I
GIVEN IS CORRECT; AND I HAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THECALL OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
Tnis eppl ,b,in nalapa ,j unllsgnod by lba
TION. AN IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
6u Id nB Olfiele PT h "", Dopuly' and Foos ale pa tl a,d
IN VIOLA T N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
lacoipl is o<knowled9otl nspaco provdod.
-
WORKME 'S COMPENSATION( URLNCE ANDRCW 182].-
DATE SIGNED
(425)
OFFICI L NATU D TE
SIG AT RE�(OWNER OR AG T
/
771-0220
R
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