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CITY':OF, EDMONDS`? ::'. ;, ;;:,,..,, .; Vti:
CONSTRUCTION' . PERMIT POLCATION:,
NAME (OR NAME OF'BUSINESS) I '
= MAILING ^ADDRESS
CITY../ / TEL'EPHONE NUMBER .(
14(rE�aj //"l/,I '%�e9 X
NAME'
ADDRESS
CITY (TELEPHONE NUMBER
FLAME
ADDRESS
CITY (TELEPHONE NUMBER
STATE LICENSE NUMBER I CITY LICENSE NUMBER
Legal Description of Property - include all easements
(show below Or attach four copies)
CNEW I_J RE51DENTIA. C PLUMBING
CADDIALTER I ElNONRESIDENT1A, I C MECHANICAL
CRFPAIR CI RETAINING 'NAG, C SIGN
rt EXCAVATE ICI FENCE
C DEMOLISH �I OR FIL. 91
CPRE MOvE NSP SWIM
COMPLIANCE I NSP C POOL
CSIDE SEWER C VIATEF• L NE C
o a n
rr a I j L
W NUMBEP OF STORIE6 NuMRFR OF
W JW t. GINb
O
M UNI I J
NATURE OF AORK TC: BE DONE AT'AL^ PLAT PE A•.
v y_
US
. hERMIT
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ADDRESS ,. .,i ir;i: i; �a-,+.+1:7-:-i,li�,y.
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LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID ENO; +`1" """• t;:+'�"
pe
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. <''
EXISTING_-______ REQUIRED DEDICATION I '•,'l.�sIlk
;i%`r�?;�
PROPOSED--_--- vct i.•_`:y
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED -'', �.�� :',4LAI.i- F`'rz
STREET USEPERMIT REQUIRED':
SEE ENGINEERING MEMO DATED— ._.LU
-` k"'
SEE PIW OE I,i,�CK LIST DATED____._____
REMARKS
ii
METER SIZE (BUILDING SUPPLY SIZE (FIXTURE UNITS
F -u
REMARKS
SIGN AREA ENV REVIEW. I ADNO.
ALLOWED PROPOSED COMPLETE EXEMPT B. '
SHORELINEM
VARIANCE OR CU PLANNING REVIEW BY IDATE
YARDS (LOT COVERAGE Z
Z
FRONT SIDE REAR Z
5
REMARKS a
CHECKED BY (TYPE OF CONSTRUCTION CODE HEIGHT
Ell I
SPECIAL INSPECTOR (AREA (OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
YES NO
REMARKS
I VALUATION
PLA:1 •
Bu,'LJrt.0
PLUMBING
MECHANICAL
I
This Permit covers .cork to De done on private property ONLY GRADiNG:F:.
Any Construction on ine puoliC dOmain iCUrbS. sidewalks. ��••-- i
driveways. marquees etc ! will require separate permission
Permit Application 180 Days
Permit Limit ' Year Provided Worm s Started Within 180 Days
gppncant cn Deh&' o' his or net spouse heirs. assigns and
vi successors in nieres: agrees tz ndemntfv defend and hold
w harmless the C'tt Edmonds Washington its officials.
employees and agents from anv anc at, claims for damages of
a whatever nature arising direcn, or indirectly from the issuance
= of this permit issuance of trils Germ,; shag' not be deemed to
modify waive or reduce ant, requirement of any city ordinance
= nor limit in an, wa. the Cn', s aoiltt, 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
authorized agent of the owner I agree to comply with city and THIS PERMIT
state laws regulating construction, and in doing the work authoriz- AUT.,ORtZES
ed thereby. no person will be employed in violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa• IVORK NOTED
lion Insurance INSPECTION
SIGNATURE IO*NER .^ A3EN' nA'E SIGNED OEPAPT M Er•T
`1 CITY OF
�t cc zit.' r� .i• c & > L— e3 5'/�J EDMONDS
ATTENTION 771 3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION -iAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3
FEE
to
APPLICATION APPROVAL
This application is not a permit until
signed by the BuildingOfficial or his
Deputy; and fees are paid, and receipt Is
acknowledged In space provided.
OFFICI:A;Lj';S NA RE - r, "6:''j
d`y
. _ 2:'.:7.
ORIGINAL — File YELLOW — Inspectof"
PINK — Owner GOLD — Assessor
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FOUNDATION
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