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CITY OF EDMOtvDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS) ADDRESS
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HARBOR SQUARE ASSOCIATES DESCRIPTION
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID 110.
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iMAILING ADDRESS
0 300 Admiral Way
CITY TELEPHONE NUMBER PUBLIC RIGHT F AY PER OFFICIAL STREET MAP, f
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Edmonds 774-8993 EXISTING REOUIREDOEDICATION._��J-/i: lC-
NAME PROPOSEDjGr. _._.. ,.^� O
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WARREN LAFON ARCHITECT
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED : w
Q ADDRESS STREET USE PERMIT REQUIRED - Z
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Ill Durbin Drive
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SEE ENGINEERING MEMO DATED
a CITY TELEPHONE IJUNin ER SEE PIW DEPT, REVIEW CHECK LIST DATED
Edmonds 774-0580 MARKS
NAME
UGET WEST CORP,
ADDRESS = ., l^ 4 U2 ! _C�
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Q 18West Dayton ME R SIZE BUILDIN SUPPLY SIZE FIXTURE ITS'
CITY TELEPHONE NUMBER r . • m
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o Edmonds 77-2712 RE A K i
STATE LICENSE NUMBER CITY LICENSE NUMBER
SIGN AREA ENV. REVIEW Ace NO.
ALLOWED PROPOSED COMPL EXEMPT
Legal Description of Property- Include all easements
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(show below or attach four copies) SHEp
ORE IN
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See Master Site Plan VARIANCE OR CU PLANN EVIEW EjY DqT
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YARDS LOT COVERAGE
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REMARKS
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LLJ NEW ❑ RESIDENTIAL ❑ PLUMBING
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❑ ADD/ALTER ❑ NON-RESIDENTIAL ❑ MECHANICAL
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❑ REPAIR ❑ RETAINING WALL ❑ SIGN
EXCAVATE FENCE CHECKED BY TYPE OF CONSTRUCTIONCODE HEIGHT
ElDEMOLISH❑ OR FILL ❑ (_-x__FT) - - t tutai `CI'lq
SWIM SPECIAL SPFCTOR AREA GCRCOUPANCY�
❑ INSP. ❑
COMPLOIANCE �.� OCCUPANT
POOL REOUIRED
❑ SIDE SEWER ❑ WATER LINE ❑ ROAD
EMARKS �, NO „P
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ifZE DEPr MEMIp iPAlI 5-11-133 g
w NUMBER OF STORIES NUMBER OF _ T - t- fru P`r 198o cpbE�_ m
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UNITSLING
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN) {- ICi�V 1�,t.J�j `Ia�7Y CLTiO�� EQn
See Attached IR
VALUATION FEE
PLAN CHECK FEE
BUILDING 3-7Z33
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGWILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application:180 Days
Permit Limit:1 Year- Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to Indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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a whatever nature, arising directly or Indirectly from the Issuance'
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= 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 TOTAL AMOUNT DUEr�1 L{.
provision." ffff
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. I 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
ad thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washingto Ing to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insuranc _ INSPECTION acknowledged In space provided.
SIGNATU DEPART
4!TE83 MENT
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OFFICIAL'S SIGNATURE
CITY OF
EDMONDS
THIS E IS LOCATED IN THE CITY
DMONDS. LOCAL SALES TAX 775.2525 DATE
ATTENTION SHOULD BE CODED 31.04.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102.78
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